HomeMy WebLinkAboutBLD2024-00351 - BLD CD Environmental Health Review - 3/18/2024 Permit No: hLel,,2/)) -rturf,!1
MASON COUNTY RECJStrede
COMMUNITY DEVELOPMENT
H- Permit Assistance Center, Building,Planning MABUILDING PERMIT APPLICATION 615W.PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATIONAME:IFF c11Toe NAME*MAILING ADDRESS:'°'°'"w°'°' MAILING ADDRESS:CITY. lILL'°'"UF STATEwAZIP:sazsa CITYPHONE 711:sL-T'x-eaTn PHONE: CELLPHONE 42: EMAIL
EMAIL:nahov�awiwuaTOusleuswm L&I REGH
PRIMARY CONTACT:. OWNER ❑ CONTRACTOR OTHER _
NAME _.. _ EMAIL IA Ni ILL IAMS-ARCH ntu s. w
MAII,INI ADDRESS IIIwitl ave vo ED.Its CITY sHocsi _. STATE -`------ ZIP.9Bs°a
PHONE CELL "A
PARCEL INFORMATION: — ------� -- --_.._._.—
PARCEL NUMBER (12 Ehga Nwnber) 11iea za°s°v ZONING nunuu
LEGAL DFSCRIPTION(Abbreviated) Tnz-A OF TR 2 OF LOT a EX a TAX 1001�A ex FIRE DISTRICT's
SITE ADDRESS W 101111 m' CITY uuIwAUP
DI RI C I IONS TO SITE ADDRESS
ISHIE PROJECT WITHIN 300 FT OF SLC I'E(S)GREATER THAN 14%: YFSQ+ NO ❑ SNOW LOAD:' psf
IS PROPER'TY WITHIN 200 FT OF THE FOLLOWING: hChOOknlltlmr anplr)'
SAL'I'WA'TER Q+ LAKE RIVER[CREEK POI WETLAND ❑ SEASONAL RUNOFF STREAM ❑
TYPE OF WORK: NEW Q+ AUDITION ALTERATION REPAIR❑ OTHER ❑
USE OF STRUCTURE (RerldI Garage CmmnercleI Bid,,L")RESIDENCE
LSUSE'. PRIMARYQ+ SEASONAL [] NUMBER OF BEDROOMS' NUMBER OF BATHROOMS'
I IEATED STRUCTURE? YES(Rvis,i dg) ❑ YES (Parr[,j SOvds 0 NO ❑
UESCR IBF WORK usw NESIRENCE with AnnCRED GARAG[
SQUARE FOOTAGE: m,Cpmd) }}. ���� 51Y�
IST I'1 OOR z,m° sq, ft 2ND FLOOR'"0 sq. ft. 3RD FLOOR N" sq.ft. BASEMENT'56° � sq_ ft.
DECK"` sT ft. COVERED DECK 144 sq.ft_ STORAGE sq_ft. OTHER sq_ft_
GARAGE 150 sq. ft. Attached E Detached❑ CARPORT T 15 sq. ft. Attached Detached❑
MANUFAC'PU ME 1NFORMA *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL _ YEAR GTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC SEWER / NEW EXISTING ❑
PLUMBING IN SIRUCTURE? YES PI NO ❑ ljyes, a¢ach completed Water Adequacy Form
PERIML I'EWFOUNDATION DRAINS PROPOSED'? YES NOO+ EXISTING SQ. FT.
EXISTING BEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS
OWNER acknowledges that submission of inaccurate information may result in a slop work order or permit revocation.Acknowledgement of such is by
slgnatnre 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 strudure(s)for review and inspection. This permitlapplication becomes null&void if work or authorized construction is not commenced within 180
days Or i1 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)
�i n Lure of OWNER (Must tee signed by the OWNER) Date
DFPAII'I'MENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC I IFALTI I
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