HomeMy WebLinkAboutBLD2023-01227 - BLD CD Environmental Health Review - 11/15/2023 •
,. MASON COUNTY Permit No:�l B?V?�-• 27
��� _ 11 v`' COMMUNITY DEVELOg-ik 2023 ti
Permit Assistance Center, Building,Planning QC I 1 /0
BUILDING PERMIT APPLICATION alder Stre: 'Q� ,s�
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: F�G� O�
NAME '/�G /�� C.G-4— NAME: ,(! /!,16 / (l l.ZL ��
MAILIW ADDRESS: 4; i 4,/ s.7C't�'J MAILING ADDRESS:S I 7[I 4 e) `� Z
CITY://?-[L.c /4k.. STATE: ZIP: `%4�('/.S CITY: (�LY(14 -/4 STATE:ti ZIP: 7..L�
PHONE#1: 4Z5 ( ') - /U Sfj PHONE: () ELL: ' G `,'[' n : XI
PHONE#2: EMAIL kr(I MC 1 4CG i e ill tt 4h - (WU
EMAILC AA j c' (!1 I4,1,1; . (.ci44 L&I REG# 'BIX KYy tPjl$C.i'- EXP.tZ /S/ Z3
PRIMARY CONTACL, OWNER 0 CONTRACTOR— OTHER 0 r- z
NAME 'era MA-C- 1.(•LI'L L EMAIL ' e� _ " 4
MAILING ADDRESS 1,U,(3OK ���e CITY(4,4 M'tl""14 STATE die ZIP rl ff� :41 =.
PHONE 3(0(, 2, v-22 ? CELL Z
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number);�(J I c`3�0 C2"J/�r' ZONING r
LEGAL DESCRIPTION(Abbreviated) 7//t'10 1`[r4I[G h%/f /)I VI FIRE DISTRICT
SITE ADDRESS CITY
DIRECTIONS TO SITE ADDRESS
TS THE PROJECT WITHIN 30U FT OF SLOPE(S)GREATER TITAN 14%: YES[ NO 0 SNOW LOAD;Z,I.) psf
TS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply)
SALTWATER❑ LAKE 0 RIVER/CREEK 0 POND 0 WETLAND 0 SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW 0 ADDITION 0 ALTERATION 0 REPAIR 0 OTHER ❑ 'tlt///C f/d '
USE OF STRUCTURE(Rer'dence,Garage,Commercial Bldg,Etc) /2!j/4 N//'/A`-•
IS USE: PRIMARY go! "SEASONAL NUMBER OF BEDROOMS NUMBER OF BATHROOMS -
HEATED STRUCTURE? YES(Whale Rug Lr YES(Parris)of Bldg)❑ NO .
DESCRIBE WORK //y'J%//I/4 !/" /1` 6(5[5 i 7 /j t i'l Alt r�L T CG[-i) I 4-(4 '
SOUARE FOOTAGE:7 O� ft ft.TAGE:07ropoved1
1ST FLOOR1i S • sq. . 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq. .
DECK 4 t"' sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.It. Attached 0 Detached 0 CARPORT sq.ft. Attached 0 Detached 0
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE I' 7tA1(i/ �M`ODEL I K/a,ill/G'i1J YEAR ZCi/3 LENGTH 7(I
WIDTH 2"/-- BEDROOMS 3l j" BATHS 2- SERIAL NUMBER Z,l. S
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC SEWER❑ / NEW❑ EXISTINGX
PLUMBING IN STRUCTURE? YESILL NO 0 If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NOD EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 2,..- 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 l 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 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) •
r-/-9/) z
Signature of OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENTED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL �,f�
PUBLIC HEALTH l741.4173 Gvf\a 5 G
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