HomeMy WebLinkAboutBLD2023-01301 - BLD CD Environmental Health Review - 10/26/2023 �� 01,4
MASON COUNTY Permit No: ✓lei 202!- i�I
\ 3 \la RECEIVED
pC COMMUNITY DEVELOPMENT
RtC,-- Permit Assistance Center, Building,Planning OCT 26 2023
BUILDING PERMIT APPLICATION
615 W. Alder Street
PROPERTY OWNERRp INFORMATION: CONTRACTOR INFORMATION:
NAME:in- r, ae,(n,1\ J` ,t.e,� kc Z NAME:
'�-� MAILING AD, RESS:yr S G— Pl)re,Lueec l YLC••MAILING ADDRESS: • ---
CITY: Skt 1-.0A STATE:/ A ZIP: 98SkLJ CITY: STATE: ZIP: M
PHONE#1: Sj -?OP-j 6 i ii PHONE: CELL: z
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PHONE#2: , 1 EMAIL:
EMAIL:q mCGlopt7.6 I�s otr►.L I.Co+tA L&I REG# EXP._/_/_
PRIMARYJ CONTACT: OWNER CONTRACTOR❑ OTtHER❑ � r►nGllle�r(u
NAME G ra�,r l�i. z EMAIL 4' Gc' Oe L LL - 768
' m
MAILING ADDRESS'�L O S t= �t Yt`V✓�u t ��c�\" CITY Ski:, K%v\ STATE U. ZIP > Z
PHONE CELL .S30—7dh—16l 1
PARCEL INFORMATION: ,5.p0gy7 = T
PARCEL NUMBER(12 Digit Number) 22/27`p-7c-'k) /c� ZONING z
LEGAL DESCRIPTION(Abbreviated) a..I.S B t-.S -rtke 'tJ 2. •II c/ FIRE DI T ICT
SITE ADDRESS 110 P CITY ' r
DIRECTIONS TO SITE ADDRES LV — /L 1 ' •
)•'
k'—'r'SS G-}- H I I( ) `" �- .ScJ .1-. .I f E x. 1, iLl
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES, NO 0 SNOW LOAD: psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER 0 LAKE 0 RIVER/CREEK❑ POND 0 WETLAND❑ SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEWA ADDITION 0 ALTERATION❑ REPAIR❑ OTHER 0
USE OF STRUCTURE(Residence,Garage,Commercial Bldg.Etc.) —f\ 'lt:A-ct/\
IS USE: PRIMARY SEASONAL❑ NUMBER OF BEDROOMS A NUMBER OF BATHROOMS a
HEATED STRUCTURE? YES(Whole Bldg)0 YES(Part(s)of Bldg.)0 NO 0
DESCRIBE WORK
SQUARE FOOTAGE:(proposed)
1ST FLOOR 1'NO sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft. Attached❑ Detached 0 CARPORT sq.ft. Attached 0 Detached❑
MANUFACTURED HOME INFORMATION: ,. *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE FT1,U I) MODELBOari(1140/') YEAR !9 y ? LENGTH oteG
WIDTH 2 I/ BEDROOMS g BATHS A SERIAL NUMBER F
• B
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC SEWER 0 / NEWg EXISTING 0
PLUMBING IN STRUCTURE? YE$:� NO❑ Ifyes,attach completedr_ Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NOOO EXISTING SQ.FT.
EXISTING BEDROOMS `&' _ PROPOSED BEDROOMS TOTAL BEDROOMS,
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 sedate that I am the owner and I further declare that I am entitled to receive this permit and to do the work as proposed.I have
obtained permission from all 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 APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
77 COUNTY CODE 14.08.42) p
x X?4 kr.y/� / �vS/�J
Signature of OWNER(Me,5igned by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL yam•_ , Q�Q��
PUBLIC HEALTH �"� �� ti3 �a. .04
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