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Home My WebLink AboutBLD2024-00412 SFR - BLD Application - 3/14/2024 Permit No: �Da oa4-bD4la- MASON COUNTY COMMUNITY DEVELOPMENT I- E C E I V E D -� Permit Assistance Center,Building,Planning BUILDING PERMIT APPLICATION MR 14 20A PROPERTY OWNER INFORMATION• CONTRACTOR I NAMER 1P1 4 S• t r>Z11C-E NAME:AM-11+3 IFORMA`IIpAl der St eat DS: s vc.MAILING D Z o o q•7 a� CITY: 14—C-0Ur.! STATE: Wa ZIP: S' CITY:_jVej-mt4 STATE:w& ZIP: 9Q,sS"$ PHONE#1:_3&* +q z� -73 PHONE:36& CELL: PHONE#2: EMAIL:.AS y 6n..st EMAIL: L&I REG#A.S ; I o; Rv4 EXP. PRIMARY CONTACT: OWNER❑ CONTRACTOR K OTHER❑ NAME JAV• a EMAIL MAILING ADDRESS Eq c'oe Zt P4 CITY STATE WIA ZIP J PHONE_3" �Vl,' 1 S •§a CELL PARCEL INFORMATION: PARCEL NUMBER(12 Digit Number) 'Z Z73 Zj—34 — gb t,i ZONING LEGAL DESCRIPTION(Abbreviated) or, SP 'j-1 FIRE DISTRICT SITE ADDRESS i O© 'S F P.1 my R b CITY_S l t.� DIRECTIONS TO SITE ADDRESS_&MCA,-f>l/! F A> L c--r S iTV- tS or.t FL IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESO NO P—SNOW LOAD:_psf IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check a!t that apply); SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑ TYPE OF WORK: NEW M ADDITION❑ ALTERATION❑ REPAIR❑ OTHER 0 USE OF STRUCTURE(Residence,GamgA Comnrerial Bldg,Etc.)_S IS USE: PRIMARY,$- SEASONAL❑ NUMBER OF BEDROOMS_ NUMBER OF BATHROOMS • S' HEATED STRUCTURE? YES(whole Bidg"lt YES(par7fsl ofBtdg)❑ NO❑ DESCRIBE WORK VZ,.l,4� µ Z&4f> SQUARE FOOTAGE:(popaseo 1 ST FLOOR 4/(7 sq.& 2ND FLOOR sq.& 3RD FLOOR sq.ft. BASEMENT sq,ft. DECK sq.ft. COVERED DECK `/Z N.8. STORAGE sq.fL OTHER sq R FPERIMETERIFOuNDATION © sq.fl. Attached If Detached❑ CARPORT sq.& Attached❑ Detached❑ TURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED* MAKEMODEL AR LENGTH BEDROOMS BATHS SERIAL NUMBER MENTAL FIEALTH ER SOURCE: SEPTICtf}- SEWER❑ / NEW(R EXISTING❑ STRUCTURE? YESIQ NO❑ Yyes,attach completed WaterAdegetacy Form FOUNDATION DRAINS PROPOSED? YES ❑ NCR EXISTING SQ.FT. EXISTING BEDROOMS PROPOSED BEDROOMS _ TOTAL BEDROOMS 3 OWNER acknowledges that submission of inaccurate Information may result Ina stop work order or permit revocation Acknowledgement of such is by signature below.1 declare that I am the owner and 1 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 regar l'mg this representative,represents that the information provided is accurate and grants employees of Mason County access to the above desc be owner d legal p and structure(s)for review and inspection.This pemtittapplication becomes null&void f 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 COUNTY CODE 14.08.42) Signa re of OWNER( uat be sinned by the OWNER) Date DEPAR NTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT FIRE MARSHAL PUBLIC HEALTH