HomeMy WebLinkAboutBLD2024-00347 - BLD CD Environmental Health Review - 3/13/2024 MASON COUNTY Permit NO: ,ei7,624 -ti) `4+
COMMUNITY DEVELOPMfflWFIV
Permit Assistance Center, Building,Planning MAR 1�3 024
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BUILDING PERMIT APPLICATION -G j NIAld §Wif
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: ;
NAME: •" r+Gto1L NAME:Hwne Homes TIM
MAILING ADDRESS: MAILING ADDRESS: 113M62ND AVE E
CITY:IS�P.��13tr STA : _ZIP: l S CITY:ruyA ue STATE:WA ZIP:98373
PHONE#1: ��(L', fnC •43 �G� rr
PHONE:383-770-3za CELL:
PHONE#2: EMAIL :Re-mmlrwlb^®nllinenomas.com
EMAIL. L&I REG#HILINW98380 EXP. 11
PRIMARY CONTACT: OWNER CONTRACTOR❑ OTHER❑
NAME EMAIL CXlJL ICCfkrv:ALIPA3�M0.%I.1d
MAILING ADDRESM�= CITY STATE ZI
PHONE ^3100•'3.foS N'd 4p CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) ps o^-7- O 11 —')L'3 •' 60 1 y ZONING
LEGAL DESCRIPTION(Abbreviated)� 1,170_ ek (mil.3tV 6P enrd�' ?3U�A FIRE DISTRICT�1—,�
SITE ADDRESS D o CITY V10.�1-PC,�q- (<A r- K'iS�
DIRECTIONS TO SITE ADDR $S *lrtsy� 9{LAr 1-,i (h 0vs L4ysyswo,4 toe l r� LC �
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"rk Vvc; W � it's ta, "lc& A— l �.e t r. — 64v. ep L `LV'-
IS THE PROJECT WITHIN 300 FT OF SLOPES)GREATER THAN 14%: YES[] NO SNOW LOAD:_Wf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Checkaathot apply):
SALTWATER❑ LAKE[] RIVER/CREEK ❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM
TYPE OF WORK: NEWA ADDITION ALTERATION REPAIR OTHER ❑
USE OF STRUCTURE(Residenre.Garrey
Commernaf Dhlg,Erc)
IS USE: PRIMARY�,��SE�ASONAL ❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS a.s
HEATED STRUCTURE. J..MIe Dm&Js� YES(Pangs]�&dg) ❑ NO❑
DESCRIBE WORK Ill P Ca! f S-1'f 11-I f l tC t C h6b,2_ .
SQUARE FOOTAGE: (propared)
I ST FLOOR "a2;; sq.ft. 2ND FLOORL sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq. It. COVERED COVERED CD D sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE ab G1 sq.ft. Altachecl Detached❑ CARPORT sq.ft. Attached❑ Detached
MANUFACTURED HOME INFORMATION: s4 COPIES OF THE FLOOR PLAN REQUIRED'
MA MODEL YEAR LENGTH
IDTH BEDROOMS BATHS SERIAL
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC• SEWER❑ / NEW'U EXISTING [I
PLUMBING IN STRUCTURE? YES)a NO❑ Ijyes, attach completed Water Adequacy Form
PERIMETERNOUNDATION DRAMS PROPOSED? YES r�NO�' EXISTING SQ.Fr.
EXISTING BEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS L-
OWNER acknowledges that submission of Inaccurate information may result in a stop Wo u order or permit revocation.AcknaMedgement 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 W 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. ThB,owner or legal
representative, information
represents that the Infoation provided is accurate and grants employees of Mason County access to the above de crtbed property
and structures)for review and Inspection. This pernlVapplication becomes null&void if work or authorized construction is not commenced within 100
days or 0 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 3 /3
Signature of OWNER i n d by the OW Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH N e
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