HomeMy WebLinkAboutBLD2024-00348 - BLD CD Environmental Health Review - 3/13/2024 Permit No: —m:�Y8
MASON COUNTYNVI RON MENTAL '.ECEIVED
COMMUNITY DEVEHORWNT MAR 13 2024
Permit Assistance Center,Building,Plann Ing
BUILDING PERMIT APPLICATION " W. Alder ee
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: 9A�
NAME:MARYRay. NAME:
MAILING ADDRESS:'°pA1" RD MAILING ADDRESS:
CITY:areiot STATE:w" ZIP:B°sw CITY: STATE: ZIP:
PHONE#1:30^"" PHONE: CELL:
PHONE#2: EMAIL
EMAIL:'"nR"wemoorua.ca. L&I REG# EXP.
PRIMARY CONTACT: OWNER❑ CONTRACTOR❑ OTHER❑
NAME ""'ce"'a EMAIL 'Ai"VAauMa M°M EMRE.Gd1
MAILINGADDRESS rm ww.aRwoAse Ra.eox+ce CITY Ses"cn STATE w" ZIP !-
PHONE mo ."' CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) ' °"°0°10 ZONING Rfl°
LEGAL DESCRIPTION(Abbmviated) TR+oRaovr L0T2M0TAxel9 FIRE DISTRICTS
SITE ADDRESS B10." Ro CITY WELT
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NO❑+ SNOW LOAD:—sf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Checkallthawtv):
SALTWATER❑+ LAKE❑ RIVER/CREEK❑ POND ❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR❑ OTHER ❑oEYa.DNEAf
USE OF STRUCTURE(Reaiderm.Garage,-Cumnumial Bldg.Ek.)RestoEueE
IS USE: PRIMARY ❑ SEASONAL Q NUMBER OF BEDROOMS' NUMBER OF BATHROOMS's
HEATED STRUCTURE? YES(Nhole Bldg) ❑ YES(Pant l oJBldg)❑v NO❑
DESCRIBE WORK Rest/REEIDENEEWm ATTA0ssbbARAGc
SQUARE FOOTAGE: tpo co,,ad)
1ST FLOOR... sq.ft. 2ND FLOOR R" sq.ft. 3RD FLOOR"" sq.ft. BASEMENT ah sq.R
DECK 5 u sq.ft. COVERED DECK" sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE e8° sq.ft. Attached EI Detached❑ CARPORT sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGEISEWER SOURCE: SEPTIC❑' SEWER❑ / NEW ❑ EXISTING❑
PLUMBING IN STRUCTURE? YES ❑' NO❑ IJyes,attach completed Water Adequacy Form
PERiMETERNOUNDATION DRAINS PROPOSED? , YES ❑+ NO❑ EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS a TOTAL BEDROOMS °
OWNER acknowledges that submission of inamorata information may result In a stop via k order or permit revocation.Paknowledgement of such is by
signature below.I declare that I am the owner and I further declare that I am entitled to receive his 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 hat he Information provided Is accurate and grants employees of Mason County access to the above described property
and sibbewre(s)for review and inspection. This permNapplicatlon becomes null 8 void If wok or authorized construction is not commenced within 180
days or H construction wok 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)
sty
ignature of OWNER (Must the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH ��f
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