HomeMy WebLinkAboutBLD2024-00081 - BLD CD Environmental Health Review - 1/23/2024 t MASON COUNTY Permit NRb lV. ('jJ.{.B M D0*1
COMMUNITY DEVELOPMENJEN 22 2024
Pernut Assistance Center,Building,Planning 615 W. A -L'I
BUILDING PERMIT APPLICATION 131014
PROPERTY OWTVER UsIFORMATION: CONTRACTOR INFORMATION:
NAME:Famu4Aaa4,1LD NAME:ewre 0mwuebn R CEI
MATING ADDRESS.PO Isms Ta MAILING ADDRESS:PO Issas Stu
CPFY:alyn STATE:WA ZIP:O6S2^ CITY:Santa STATE:WA ZIP:M
PHONE NI:RNtiW. S PHONE: CELL:3fA5G6IJU =. 0
PHONE 42: EMAIL:eoowbme@a.wm
EMAIL: L&T REG pBIIsJISLI EXP.
PRIMARY CONTACT: OWNER CONTRACTOR El OTHER❑ rl
NAME m—s' EMAIL m
MAILINGADDRESS PO Oea Ta CITY says STATE Wen 21PMIsM i� Z
PHONE s^easaws CELL
PARCEL INFORMATION: D
PARCEL NUMBER(12 Digit Nanber)22MULWaa ZONINGSF r
LEGAL DESCRIPTION IAbbrevidtcd) FIRE DISTRICT
SITE ADDRESSM NC TNaIya RW Rd C TNIuye
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300"OF SLOPES)GREATER THAN IJK: YES[] NOB SNOWLOAD:20 pd
ISPROPERTY WITHIN2MFTOFTHEFOLLOWINC: ICkxanll,Mr seAS/�
SALTWATER❑ LAKE[] RIVER/CREEK[] POND❑ WETLAND SE.ASONALRUNOFF[] STREAM❑
TYPE OF WORK: NEW[] ADDITION ALTERATION REPAIR[I OTHER TI
USE OF STRUCTURE(AUWmm Came.Ca.a-aalay.Eaa)
IS USE: PRIMARY El SEASONAL NUMBEROF9EDROOMS3 NUMBEROF BATHROOMF2
HEATED STRUCTURE? YES(Isoi, (I B YES rra,yy ar'a a❑ NO
DESCRIBEWORKOepvne191pn Md MlpMmaaMl New MIg Rome
SOVARE FOOTAGE:msnawdr
1ST FLOOR120Is M.ft 2ND FLOOR aq.R. 3RDFLOOR sq.A. BASEMENT_sq.R.
DECK eq.ft COV®iP.D DECK sq.ft STORAGE sq.R. OTHER sq.A.
GARAGE eq.A. Atwehed[] Detached CARPORT sq.O. ANochad[] DeerhN❑
MANUFACTURED HOME INFORMATION: ed COPIES OF THE FLOOR PLAN REQUIRED-
MAKEPeImHarbv MODEL \T'AR2322 1E11TN2A
WIDTH. BEOROOMS3 BATli82 SERW.NUMBER
ENVIRONMFNfAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTICO SEWER❑ / NEW[] E%1STINGO
PLUMBINGINSTRUCTURE? YESO NO[I g3ws.arms,h aaaap4IM Water Adegaacy Form
PERIMETERM)UNDATION DRAINS PROPOSED? YES❑ NOE] EXISTING SQ.FT.12%
EXISTING BEDROOMS 3 PROPOSED BEDROOMS TOTAL BEDROOMS
OWNER aekri(y.INgsa may autm%aim DI inemmate inlwmatm may maUt In a sop—ra ONvv pecan reroc mom PekrcvAergemenl N sud,b Ey,
epreWre bdaw.l eetlare Mel I em IM—atl Ammar a.d.m Net l am enlNetl to reu'KIFIe penria aM b W Ne wM ate pm. I Nate
Mlaine0 pe,mis4im M1pn ell Ma rnceeeary paNes.indublrg any eaeement M1d.Jer or paNmot TIereS regareliq Nla pmlett lNe awier vlegY
mpna.mm( ).rmanLLMMNe InMmatgn pNVlem6aUurale mOgrmla emgpyee4INM%pn CDunrys Fhb NeaWve Ee%nMpopBM
yd nitWuralBllw reNewane Inepemi0rt Thi4 pennNBppllcaAm becOmm ndl8 voii tl wvk or aNM1Mzee concw Wn is ml vmrnencW MMin 18p
my4 a Nmneo-Ormi wem'w a�aceneee mr a perm IN sw eaya.
PROOF OF NFINUATION OFYWORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMR PLICATION 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.IMABON
COUNTY CODE 14.09.42)
Bi]reWm NOWNER(Must be alamd by the OWNER) nap
DEPARTMENTALREVTHW APPROVED DATE DENIED DATE TAGS/NOTMICONI)MONS
BUILDLNGDEPARTMENT
PLANNING DEPARIMENT
FIRE MARSHAL
PUBLIC HEALTH
1
p 3n S'p 40 .4C,
P/
E�plxrs L7ci'�, L1C
psLPcsFL'� zz�,-arf-�''�
ROd : Gc.Yt: ryL/6P Oc✓,Ii ,
EH Setbacks
A.) Drainliekl/Reseme requires 10'setbackhom footingfloundations
B.)Septic Mitts)requires 5'setback from all foolinfiftundallons
C.)No foundation/Perimeter Drains within 301t,downgradient of
Drainheld/Rewhre area
D.)No Cut Banks)(greater than 5h and aver 45 degrees)within
5011,down gradient of DrainfieldlResem area
EH APPROVED R�nq yE
Rhondalhompson OP/16,=4 $,6 W Sc>
1 l
) I
�. =ry
C� —fE a
l
t
s w
t
4Qy
y Y
9a '
PjLd c20 o2�-6Cb G