HomeMy WebLinkAboutBLD2024-00336 - BLD CD Environmental Health Review - 6/12/2024 MASON COUNTY Permit �"
COMMUNITY DEVELOPMENT MAR 12 M§
Permit Assistance Center,Building,Planning
615 W. Alder Street
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATI
NAME:aETH WWWSA AWEEAILEN NAME: > C
MAILING ADDRESS:45o 5E sew DER H LANE MAILING ADDRESS:
CITY:s �e STATE:wA 7IP:0`w CITY: STATE: ry�p
PHONE#1:4 X16 PHONE: CELL: 2
PHONE#2:m.eswsu EMAIL:
EMAIL:m"'amla.^°".w.".N'^"yNroe®u""m"' L&I REG# / .
PRIMARY CONTACT: OWNER❑ CONTRACTOR❑ OTHER❑
NAME '—I EMAIL aYIYWILLWAa""u"'E°^'AEco" r^
MAILING ADDRESS em w1.0.A.Ro.BOX IN CITY -'-.TON STATE wA ZIP seB4
PHONE seem a"' CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) a0Z0 ss°°060 ZONING auaAL s
LEGAL DESCRIPTION(Abbreviated) e IOFauw4-orsTi.swWElrzWM.NLYOrrvxnn41Nr1 FIREDISTRICT4
SITE ADDRESS.8E SEA DER HJK LANE CITY SHELTM
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NO O+ SNOW LOAD:2L—psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (CAeckandiatspply): -
SALTWATER Ew LAKE❑ RIVER/CREEK❑ POND,[] WETLAND❑ SEASONAL RUNOFF❑ STREAM
TYPE OF WORK: NEW❑ ADDITION❑ ALTERATION El REPAIR❑ OTHER ❑
USE OF STRUCTURE(Ea/deace,Garage,Commercial Bldg,Etc...RESIDENCE
IS USE: PRIMARY 0+ SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS'
HEATED STRUCTUREI YES(Whole Bldg)❑ YES(Porr(sI oJB/dg)E+ NO
DESCRIBE WORK A TERATIDN Of EXISM STmCNRE
SOUARE FOOTAGE: (.pea d) O er 50�7o R.rY10� .R-U oei o n t q
1ST FLOOR 1�' -sq.ft. 2ND FLOOR 1 sq.ft. 3RD FLOOR sq.ft. BASEMENT 80b sq.It.
DECK_ sq.ft. COVERED DECK sq.ft STORAGE sq.ft. OTHER A sq.ft.
GARAGE sq.ft. Attached❑ Detached❑ CARPORT sq. ft Attached❑ Detached
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL LENGTH
W TH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWERSOURCE: SEPTIC El SEWER / NEW EXISTING El
PLUMBING IN STRUCTURE? YES 0+ NO❑ If yes, attach completed WaterAdeguacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ Ee I EXISTING IQ.Ff.
CHsA NO
EXISTING BEDROOMS N }IS PROPOSED BEDROOMS TOTALBEDROOMS
OWNER acknowledges that submission of Inamorata information may result Ina stop work order or permit revocation.Acknowledgement of such is by
signature below.I declare that I am the owner and I further declare that I am enthled 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 f information provided is accurate and grante employees of Mason County access to the above desedhed property
and structure(s)for review and inspection. This peanNepplication becarees null a void a work or authorized emretrucgon in;not commenced within 180
days or 0 construction work Is suspended for a period of 1W clays.
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 ?1t Z,/ 2 tl
S' afore of OWNER(Must be sinned by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL ��A ,,�
PUBLIC HEALTH C*.`L?