HomeMy WebLinkAboutBLD2023-00955 - BLD CD Environmental Health Review - 10/3/2023 Permit No:
dLQaba3-Od 55'
A MASON COUNTY
i ECEIVE
t i ) COMMUNITY DEVELOPMENT AM
k Permit Assistance Center,Building,Planning
�' �4UG 10 2023 OCT 0 3 2023
BUILDING PERMIT APPLICATIO ..
/.Uj PROPERTY OWNER INFORMATION: CONTRACAIIIRI � NStrCet Lr..,,,.RECEIVED r
1 - NAME:AIGI1RA,�d Motr1 s b#b NAME: w i s �+i
MAILING ADDRESS: * 'a o MAILING ADDRESS: E I . v'I RC N#UI E NTAL
CIT7- PH TA 3GO 4,I g7`Zi: ` PHONE: STATE:CELL: ZlI SALTH
PHO #1: ..
a— PHONE#2: ixb G ty I g 76 EMAIL:
m EMAIL: L&I REG# EXP._/ /_—
QPRIMARY CONT T: •• OWNER' CONTRACTOR 0 OTHER❑
L1 a
NAME rC 4A C 1/jfa/f EMAIL T�r� 2/ 0$ 4/ifCICitlV44i 0I'.—(_
MAILING ADDRESS/�/i/ .C#1 M S CITl��fDr€L.. STATE_21P 4 4
E PHONE CELL_' { 2..
( .. PARCEL INFORMATION:
2 PARCEL NUMBER(12 Digit Number) 12 10 4- s i OOO o l_ZONING ris IV viol a q
LEGAL DESCRIPTION(Abbreviated) Q FIRES DISTRICT
SITE ADDRESS go E. g(A V'�/6rr! % R. bp
CITY s ifr4 mt r
DIRECTIONS TO SITE ADDRESS
I. /w r f .w A 0 ts✓-G
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO 0 SNOW LOAD: osf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER LAKE 0 RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM 0
TYPE OF WORK: NEWS ADDITION 0 ALTERATION❑ REPAIR 0 OTHER ❑
USE OF STRUCTURE(Residence,Gorge,Commercial Bldg.Etc.) f1Gjt/Itta,#;4 1/tipotess .
IS USE: PRIMARY 9, SEASONAL 0 NUMBER OF BEDROOMS 2 NUMBER OF BATHROOMS 2—
HEATED STRUCTURE? YES(whore Bldg)V YES(Parris)of Bldg)0 NO❑
DESCRIBE WORK
SQUARE FOOTAGE:(proposed)
1ST FLOOR I 2-eeq.ft. 2ND FLOOR tV...sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft
DECK R.71,sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft
GARAGE sq.ft. Attached 0 Detached 0 CARPORT sq.ft Attached 0 Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC SEWER 0 / NEI EXISTING 0
PLUMBING IN STRUCTURE? YES? NO❑ If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NOD EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS ?/ TOTAL BEDROOMS Z
OWNER acknowledges that submission of Inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by
signature below.I declare that lam the owner and I further declare that I am entitled to receive this permit and to do the work as proposed.I have
obtained pemrssion from at the necessary parties,including any easement holder or parties of interest regarding this project The owner or legal
representative,represents that the information provided is accurate and grants employees of Mason County access to the above described property
and structure(s)for review and inspection. This permit/application becomes null&void if work or authorized construction is not commenced within 180
days or if construction work is suspended for a period of 180 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT A TION QE.180 DAY F MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
i OUNTY CODE 14.08.42)
X `7/3/ 23
Sign of ust be signed by the OWNER) ate
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL �h � �
PUBLIC HEALTH tO►W/(i3 " r"""1 c s�`�" L
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