HomeMy WebLinkAboutBLD2023-01260 - BLD CD Environmental Health Review - 10/17/2023 to-bading_permitapp.pdt nupsI/masoncounrywagov11ormsn,ummumry_uewouuwugycrmn._
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MASON COUNTY Permit No: 3 ~ ,owsth a to b
r1 COMMUNITY DEVELOPMENT OCT 17 2023
Permit Assistance Center,Building,Planning
BUILDING PERMIT APPLICATION 615 W. Alder Street
PROPERTY OWNER INFORMATION: (//1 CONTRACTOR INFORMATION:
NAME: '4' c_ rS t-
et.. c. uff'C NAME:
MAILING D S: e:e,4L.MAILING ADDRESS: ENVIRONMENTAL
CITY:s d.� STATE:w ZIP: - y CITY: STATE: ZIP:PHONE#1: O:� _,�-G J 7 PHONE: CELL: H EA LT H
PHONE#7,: EMAIL: ——
EMAIL: C ..,,.,--7,,/ L&I REG# EXP. / /
PRIMAR CO ACT: 'NER CONTRACTOR❑ OTHER❑ /J //
NAME "z <t EMAIL .— G 0'? Wit' 1 cl� 'W ��i
MAILING ADDRESS .[ L-I"4//1 ref 4it•CI_ STATE /�ZIP z(
PHONE (ICELL f,�is�,/�'.,�-cj
PARCEL INFORMATION: f ( 1 l /) \ I� 'A� j�
PARCEL NUMBER(12 Digit Number) / // g-\r., -el on 3/ ZONING-0"..g 4- �..-./�`�/ Cs `�✓C
• LEGAL DESCRIPTION�/ (Abbreviated) FIRE DISTRICTS ` -`-fc-///1Cn..Yae--
SITE ADDRESS T . Lr C. 4 r CITY Sdi e//4t 2•i�
DInCT1ON TO TE ADDRESS 0
' IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN I4%: YES❑ NO❑ SNOW LOAD: psf
IS PROPERTY WITHIN 200 FT OF TILE FOLLOWING: (Cheek all dmm apply):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW 0 ADDITION ALTERATION❑ REPAIR ] OTHER 0
,[ r
' USE OF STRUCTURE(Residence,Garage,Corarrre lal Bldg,Err.) f -4 S 1 C', f514- / /, r//�.�
IS USE: PRIMARY 0 SEASONAL NUMBER OF BEDROOMS / NUMBER OF B MS
HEATED STRUCTURRE? YES(n'holeBldg) YES rpryplrjafBldgl❑ NO El / ' i 1
DESCRIBE WORK`cti ce\.L.Pe / [.I�•7,✓`e-s A. "••�-1 -r C�_•"�-t rn� cS /i t, „ sr,.
,.e-e
SQUARE FOOTAGE:(proparer) ty
1ST FLOOR 'sq.ft. 2ND FLOORAigiig sq.ft. 3RD FLOOR sq.ft. BASEMENT/di 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❑ 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�/ NEW 0 EXISTING
PLUMBING IN STRUCTURE? YES{� NO❑ If yes,wrath Water.4dequacy Form
.PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NOD EXISTING SQ.FT. ` r�'�
BI
• EXISTING BEDROOMS PROPOSED BEDROOMS J TOTAL BEDROOMS ,//wt/_ nc�
OWNER acknowledges that submission of inaccurate Information may result in a slop work order or permit revocation.Acknowledgement of such is by Y C V `
signature below.r declare that I are the owner and I further declare that I ern entitled to receive the permit and to do the work as proposed.I hove \ /'S +``
obtained permissionersea all the necessary parties,po including u ate and grtants
is holder or of interest ce is 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 permiVapplicalion becomes null&void if work or auloraed construction is not commenced withn 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 l
X /PERMIT LICATI N OF DAYS OF MORE VYIt CAUSE THE APPLICATION TO BE EXPIRED.(MASON O VIA►_
COON C DE 14.08.42) �
-Slgna lJre of O NR(must be si ne y the OWNER) Date \` 'Y
DEPARTMENTAL REVIEW P VED DATE DENIED DATE TAGS/NOTES/CONDITIONS �\
BUILDING DEPARTMENT (�/
PLANNING DEPARTMENT v
FIRE MARSHAL �(�
PUBLIC HEALTH y J J It(3)rt/_s