HomeMy WebLinkAboutBLD2024-00194 - BLD CD Environmental Health Review - 2/13/2024 Permit No•rltd z4-mtg4
MASON COUNTY RECEIV
COMMUNITY DEVELOPMENT
Permit Assistance Center,Building,Planning FEB 01 4Zj -?k
BUILDING PERMIT APPLICATION 615 W. Alder StINFORMATION: CONTRACTORINFORMATION:
NAME:Miesh Naleinson NAME:O°Ter
MAILING ADDRESS:ro sos 1519 MAILING ADDRESS: J
CITY:sheaan STATE:We ZIP: CTfy: STATE: ZIP:��
PHONE#1:Bsoseaaass PHONE: CELL: ._
PHONE#2: EMAIL:
EMAIL:heNereadaYgnnc®ouewkmm L&I REG# EXP. /
PRIMARY CO WNER❑+ CONTRACTOR❑ OTHER❑ W
NAME s. EMAIL
WGADDRESS CITY
E CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 22228-8142001 ZONING Ras
LEGAL DESCRIPTION(Abbreviated) 1Ra1LS END d 112131 :2 LW'.l U 1Aa 21+CL 10F BUM 28 FIRE DISTRICT Fire Dlahid 6
SITE ADDRESS 211 E TRAILS END DR CITY Beltalr
DIRECTIONS TO SITE ADDRESS From E Tmik Rd tum mb E Tmik and Dr.pamN bjuN peer Community Wadley down aw hgl realm lake outlb
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%; YES❑r NO❑ SNOW LOAD:2?2sf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Chickallthatapply):
SALTWATER❑ LAKE❑+ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK. NEW❑+ ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑ ]
USE OF STRUCTURE(ReaNma,Ganw,ConveeromlB*Erc)6'gw bmly resMmwe 3
IS USE: PRIMARY❑+ SEASONAL❑ NUMBER OF BEDROOMS 2 NUMBER OF BATHROOMS 2
HEATED STRUCTURE? YES(whole Bldg)❑ YES(Parr[.)oJBldgt 0 NO❑
DESCRIBE WORK New mnaburLw
a
SOU RF�e FOOTAGE: m�a
IST FT.00Rj�sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT — sq.R
DECK sq.It COVERED DECK sq.R STORAGE sq.ft. OTHER sq.R
GARAGE 1I a+ sq.ft. Attached Detached❑ CARPORT sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: w4 COPIES OF THE FLOORPLAN REQUHIEDe
IIIAICE MODEL YEAR LENGTH
BEDROOMS BATHS SER11eZT]DPIS1Slt-
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC 0 SEWER❑ / NEW❑+ EXISTING❑
PLUMBING IN STRUCTURE? YES ❑+ NO❑ byes, attach completed Water Adequacy Form
PERIIdETER/FOUNDATION DRAINS PROPOSED? YES❑+ NO[] EXISTING SQ.FT.
EXISTING BEDROOMS Q _ PROPOSED BEDROOMS ;I, TOTAL BEDROOMS 2
OWNER acknowledges that submission of inaaurete information may result in a stop work order or permit revocation.Acknowledgement of such is by
signature below.)declare that I am the owner and I further declare that I am entitled to receNe this permit and to do the work as proposed.I have
obtalnw permission from all the necessary parties,including any easement holder or parties of interest regarding this project The owner or legal
reoreseoath0i reoreseoe mature information provided is acourele and armor emolovees of Mason County access to Me above descnbed orooer v
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