HomeMy WebLinkAboutBLD2023-01186 - BLD CD Environmental Health Review - 11/13/2023 t
: : )i . MASON COUNTY Permit No: "�1C1 �?��� -oii�
,` k COMM COMMUNITY DEVELOPMENT
'44,141 ,. ' Permit'Assistance Center,PUiiGlrg;Plt3nniP.L ��
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L ( BUILDING PERMIT APPLICATION NOV 1 3 �013
PRO ERTY OWNER INFORMATION: CONTRACTOR INFORMATION: RECEIVED
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ONO U AM Th—L.1{J 5
1 S l-4� IV) C YVI BeQl,A 1 tJ NAME:GIZE6 (Y 'l e-e.$ Ur_
w A G ADDRESS2301 CAP k W pm S 3 MAILING ADDRESS: T.0. S3ox 33 +
TIT STATE:W pt ZIP:gfSo I CITY:FftifJr- STATE:, ZIP: q e n ,
PHONE#1: 3(oo 451 3a(oo PHON ► i CELL: 3(06 2_3ci Q5yo
PHO 42: 2.S3 €ZO Ojtic EMAIL :C-1I CamyEeSLLC ® GmF1;L • COtY1
EMAIL: CCPrt.YOSNi2.d 6 rt- iL.C.4m L&l REG#69.Z.6MAIL452.49IYIS EXP. 7 /02/ 24
PRIMARY CONTACT: OWNERI% CONTRACTOR❑ OTHER 0
a NAME C.H1?iS CAArYtiltL921Att`./ EMAIL C o$N-12®C WI 1L•C.-00
-J MAILING ADDRESS 2.301 C';t oL (.JPA. S -* 3 CITY (Dui M:114- STATE W A ZIP q35o)
<`• PRONE 3ioo 4S 1 315(00 -<—may
RCEL INFORMATION:
RCEL NUMBER(12 Digit Number) 32.O O$-43- 1 I0 0 2 1 ZONING
OCEGAL DESCRIPTION (Abbreviated) T12. Z-A OF L3 1/Z Se'TR- I of Sr tttge'IRE DISTRICT )
E ADDRESS 30'7 C C W tFIL P Aiiti 120 CITY S14-ElTO I.). CTIONS TO SITE ADDRESS 5o14t.1S •1 RA;�►1E 12D ) 5otiVel 0t.) C RitOL,N1a. v'O)
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LU IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES': NO g SNOW LOAD:2S#psf
IS PROPERTY WITHIN 200 FT OF TILE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE ❑ RIVER/CREEK 0 POND 0 WETLAND 0 SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW rg ADDITION ❑ ALTERATION ❑ REPAIR❑ OTHER 0
\..0 USE OF STRUCTURE (Residence,Garage,commercial Bldg,Etc.)
IS USE: PRIMARY/21 SEASONAL 0 NUMBER OF BEDROOMS 4 NUMBER OF BATHROOMS 3
.-- ' HEATED STRUCTURE? YES WWhole.Bldg) 0 YES (Part[s]of Bldg)gi NO ❑
t DESCRIBE WORK NtEUJ t4DCYM C o1.)ST'e kCTi OtJ
M
N SQUARE FOOTAGE: (proposed)
^' 1ST FLOOR Z.(o72. sq. ft. 2ND FLOOR 11 sq. ft. 3RD FLOOR sq. R. BASEMENT sq. ft.
,,
DECK sq. ft. COVERED DECK `3 sq.ft. STORAGE sq. ft. OTHER` _ sq. ft.
GARAGE log-1 sq. ft. Attached tg Detached❑ CARPORT sq. ft. Attached❑ Detached 0
MANUFACTURED NFflR1YI ' xY.• *4 COPIES OF THE FLOOR PT.AN REQUIRED*
MAKE MODEL YE LENGTH
TI-I BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC sit SEWER❑ / NEW liz EXISTING❑
PLUMBING IN STRUCTURE? YES, NO 0 If yes,attach completed Water Adequacy Form r
PERIMETER/FOUNDATION DRAINS PROPOSED? YES ❑ NON, EXISTING SQ.FT. ,
EXISTING BEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS 4 t/
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)
x0 - 6 -202"S
Signature of OWNER(Must be signed by the OWNER) Date
.. ,,, .,:..;.: ;rs. zr ;-;. ..:� ,i. ,, u .. .......... ..:.... __..,_: .. ..v:oaacooaa,o-yxoac�.i ,•ac:a r�,v �< -'z.;aas:. < -.ca,- .ra Y&Sr•:
DEPARTMENTAL REVIEW , APPROVED: DATE • DENIED DATE s'TAGS/NOTLS/CONDITIONS,
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL PUBLIC HEALTH 12Z1
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