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HomeMy WebLinkAboutBLD2023-01385 SFR - BLD Application - 11/15/2023 MASON COUNTY Permit Noh/ f)"')Q3 COMMUNITY DEVELO I V E D Permit Assistance Center, Building,Planning BUILDING PERMIT APPLICATION NOV 15 2023 PROPERTY OWNER INFORMATION: CONTRACTOR IRFMWT*hit e r Street NAME: P�ff_r NAMEMAILING D S: MAILING ADDRESS CITY: AT ZIP: CITY: _STATEI ZIP: PHONE#1:' — r PHONE:_ PHONE 42: G11 ©O EMAIL EMAII 1 S�P C C3lYl CCacf ! L&I REG h —— PRIMARY CONTACT: OWNER❑ CONTRACTOR OTHER❑ NAME C 4 EMAIL MAILING ADDRESS CITY Lbaa, STATE ZI PHONE CELL PARCEL INFORMATION: PARCEL NUMBER(12 Digit Number) `( A--26 ZONING — LEGAL DESCRIPTION(Abbreviated)i 0d n De—(V-11 r---rk.76 f i I fi i JJIICA FIRE DISTRICT SITE ADDRESS_)I I F- WAd—i{'P >1 I)n • CITY Q A DIRECTIONS TO STPE ADDRESS IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YE NO J$ SNOW LOAD:_psf IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Checkall that apply): 06M.0. SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ ,STTR.'EjAM❑ TYPE OF WORK: NEW❑ ADDITION❑ ALTTERATION❑ REPAIR❑ OTHER M 0 C USE OF STRUCTURE(Rmdeace,Garage,Comme-al Bldg,E-) IS USE: PRIMARY❑ SEASONAL M NUMBER OF BEDROOMS_NUMBER OF BATHROOMS HEATED STRUCTURE? YE+ (Whole Bldg)® YES(Part[s]of Bldg)❑ NO❑ r DESCRIBE WORK AVDV '5F_J1QV3e'— I e ` SQUARE FOOTAGE:(propa.4 1 ST FLO q.ft. 2ND FLOOR"---sy.ft. 3RD FLOOR----'--T R:' BASEMENT-----' sq.ft. DECK- sq.ft. COVERED DECK — —sq.ft. STORAGE sq.'ft.' OTHER-'sq.ft. GARAGE q.ft. Attached❑ Detached❑ CARPORT '� sq.ft. Attached❑ Detached❑ MANUFACTURW HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED* MAKE MODEL YEAR LENGTH WIDTH B DROOMS BATHS SERIAL NUMBER ENVIRONMENTAL HEALTH: SEWAGE/SEWER SOURCE: SEPTIC❑ SEWER❑Alfylesat NAom EXISTING❑ PLUMBING IN STRUCTURE? YES❑ NO❑ t ater Adequacy Form PERIMETERNOUNDATION DRAINS PROPOSED? YEXISTING SQ.Fr. EXISTING BEDROOMS PROPOSED BEDR TAL BEDROOMS OWNER acknowledges that subm informai ission of inaccurate on may result in a stop work order or pertnil revocation.Acknowledgement of wch 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 1[ • COUNTY CODE 14.08.42) r X r, , I L. t tgnature of O N j At be'si n d b the OWNER to DT,P tTMENTALREVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT Q 6 PLANNING DEPARTMENT FIRE MARSHAL PUBLIC HEALTH OIL _ O Tel E!�EIVE �rar NOV 15 2023 Ald Street E � Lr ti SOL#.& I _:so f f e Piing - f