HomeMy WebLinkAboutBLD2023-01302 - BLD CD Environmental Health Review - 10/26/2023 Ag
MASON COUNTY Permit No: "P)Id 310 - I 170
QCEIVED
COMMUNITY DEVELOPMENT
(3/
Permit Assistance Center, Building,Planning OCT 26 2023
BUILDING PERMIT APPLICATION 615 W. Alder Street
11) PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:j7rarlE.(u e3-EuAe1 f.c,pez NAME:
Q MAILING AD SS: L/(,O $ Ft I eu t� �. MAILING ADDRESS: rn
CITY: 5 Ile., k� STATE•• '4 ZIP: SYf3�8. CITY: STATE: ZIP: z
PHONE#I: S O 76 _/6 /.f PHONE: CELL:
PHONE#2: i EMAIL:cls--
EMAIL:g rc g, O1F7 17�.�t11,a11'CLr KA L&I REG# EXP._/ /_ _ DJ
J m O
PRIMARY CONTACT: OWNER CONTRACTOR 0 OTHER 0 e. I D Z
NAME C.-1rc e II n EMAIL <4 e IdPLLG'�7/r '�K10.L -few',
MAILING ADDRESS �I6O SL Ft f eil @eC•1 !'r,ti� _ CITY c r STATE 1.L t/S"ZIP9F1 red/ — S
PHONE .i.30-76p--ix/y CELL �j rTl
PARCEL INFORMATION: -7 �v�'�d7 o r$ z
PARCEL NUMBER(12 Digit Number) R 1,2./-7J - C) i S� ZONING R D
LEGAL DESCRIPTION(Abbrc iatcd) / Y S, FIRE DI RICT r—
SITE ADDRESS ) — •' d CITY
DIRECTIONS TO SITE AD'D/�,/SS [,iJ.43I /L--F I t Wyk\ I2. U� A/ t!. u r ,��r- L
L- & 5,,�,k,';� full 12r • n— c SLr,..c��f �,/ $z J L- Passuy Vt F.IL'
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YEk NO 0 SNOW LOAD: psf L i 3 1202
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply): vJ
SALTWATER 0 LAKE 0 RIVER/CREEK 0 POND 0 WETLAND 0 SEASONAL RUNOFF 0 STREAM 0 RECEIVED
TYPE OF WORK: NEW X ADDITION 0 ALTERATION 0 REPAIR 0 OTHER 0 .w.......'
/0y4, USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.) R'C.. I�-e y
IS USE: PRIMARY SEASONAL 0 NUMBER OF BEDROOMS_
/( NUMBER OF BATHROOMS,
HEATED STRUCTURE? YES(Whole Bid ❑ YES(Parr(sj of 81 g)0 NO❑
DESCRIBE WORK talc) 1.$S t ati,.)
SQUARE FOOTAGE:(proposed) p rolt "'
1ST FLOOR3rf 1 sq.II. 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 0 Detached 0 CARPORT sq.ft. Attached 0 Detached 0
MANUFACTURED HOME INFORMATION:��I2 �]2 *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE TJ MODEL) a._3 7.3 / YEAR ,.ZG�a, LENGTH gaiiI0 A.
WIDTH I a\ BEDROOMS 1 BATHS ` SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC SEWER 0 / NEW❑ EXISTING
PLUMBING IN STRUCTURE? YES 0 NO 0 If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NOD EXISTING SQ.FT._.
EXISTING BEDROOMS - PROPOSED BEDROOMS 1 TOTAL BEDROOMS ,1 f,/
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 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 permitlapplication becomes null 8 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
COUNTY CODE 14.08.42)
x tea 9f zrie3
Signature of OWNER( ust be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH lie; Ir ‘tAZOLI L 4,11 CI.144,9.4
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