HomeMy WebLinkAboutBLD2023-00638 - BLD CD Environmental Health Review - 6/8/2023 JUN 0 8 2023
RECEIVED /� ^
ermit No: -- 60/523 g
., .. MASON COUNTY RE E I V E D
COMMUNITY DEVELOPMENT
N; Permit Assistance Center,Building,Planning JUN — 6 202
BUILDING PERMIT APPLICATION: ;; W t� ✓#I R 1 V M E NTAL
Al Strec
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: H F A I_TH
NAME: Mho_ Poet's NAME: J Nee� OIL'OIL't,J V S N 1:- (IG
MAILING RESS: l 0 C.ffl/4COYt 1.14 J)I VkI MAILING AD RE S: Zt ►/j N W ticiCi' MIS 1(yZ
CITY:(y RJ1ety STATE:WA ZIP:gkG. la CITY:L('I)vrrcictL STATE: J4 ZIP:
PHONE#1:I PHONE:.'" • - CELL:
PHONE#2: EMAIL: C - I- •firrY✓
EMAIL: L&I REG j o -6)1 EXP. `t/ I /24
PRIMARY CONTACT: OWNER❑ CONTRACTOR 51 OTHER D
NAME re4 jr1[/G2i' EMAIL dS{pLtbu,/ YI6.));Vetrer>y,
MAILING ADDRESS� )/, NI wt krJC..1 1i✓L.tp) I1F2- CITY e/ol tLt STATE Ittg ZIP'jjjg.3
PHONE30 1 ly-73 /1 CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 2.2,tC.5 -S)-000 d 5 ZONING
LEGAL DESCRIPTION(Abbreviated) i FIRE DISTRICT
SITE ADDRESS Lk tU et E• �ASOlti )V. 1�( CITY )'JYU 1P W
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO❑ SNOW LOAD:_psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER 0 LAKE 5 RIVER/CREEK 0 POND❑ WETLAND❑ SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW❑ ADDITION RI ALTERATION 0 REPAIR 0 OTHER f1
USE OF STRUCTURE(Residence,Garage,Commercial Bldg.Etc.) 145160 Ge
IS USE: PRIMARY 0 SEASONAL 0 NUMBER OF BEDROOMS NUMBER OF BATHROOMS'S
HEATED STRUCTURE? YES(Whole Bldg)til YES(rants of Bldg)❑ NO❑ J ,7
DESCRIBE WORK /LIf� '1 LXt,bvj itlUY14Vtj rYLl MA dCt3 D�MV t,X144 ni i4,24 �'IPW 1-C
SQUARE FOOTAGE:(proposed)
1ST FLOOR sq.ft. 2ND FLOOR I 1.1 sq.ft. 3RD FLOOR sq.IL 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: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
1 SEWAGE/SEWER SOURCE: SEPTIC gi SEWER 0 / NEW❑ EXISTING gil
PLUMBING IN STRUCTURE? YES 0 NO 51 If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NOD EXISTING SQ.FT.
EXISTING BEDROOMS o?.-- PROPOSED BEDROOMS 0 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 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 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
COUNTY CODE 14.08.42)
X
C. lG l _-
Signature of OWNER(Must be signed by the OWNER) Date'
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT FIRMARSHAL iigi tie./A ' a? 11/110 Cowlr m Ot ere/
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APPROVES - ' _
NOV 2 7 2023
MASON COUNTY ENVIRONMENTAL H •LTH
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DiDION►OR: Site Address: — — •ELBYDlf16N•LTD. email:pt.selby(Dyahoo.com
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