HomeMy WebLinkAboutBLD2024-00873 Skylights - BLD Application - 7/22/2024 MASON COUNTY Permit No: LZ2u'f,2'L6 6j3
COMMUNITY DEVELOPMENT RECEI Em
Permit Assistance Center,Building,Planning JUL 2 2 2024
BUILDING PERMIT APPLICATION 615 W. Alder Street C
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PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: ftW4V, ' C3". NAME: 449(S -
MAILING ADD SS: 10( -¢ MAILING ADDRES : -
CITY: STATE: ZIP: CITY: STA ZIP:
PHONE#1: 20 PHONE: CELL: 3 - 'e- 62 z
PHONE#2: EMAIL: 'f-^ cOtt
EMAIL: aAlb. L&I REG# 2-
PRIMARY CONTACT: OWNER❑/ CONTRACTOR❑ OT ER❑
NAME = EMAIL d.2,�1Gi. IG A-� Q Gt-C 1,Cft17
MAILIN DDR S ) CITY "T t TA��I(9 ZIP_QC l
PHONE - CELL G nYVI
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) ZONING
LEGAL DESCRIPTION(Abbreviated) '5 1nf G L—F-A(b114-z( t fo M [-, FIRE DISTRICT
SITE ADDRESS S /o ' CITY S A7:R--T0
DIRECTIONS TO SITE ADDRESS (LArS4 -L
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NO NOW LOAD:,2.5-psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW❑ ADDITION 0' ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.) �°,�5/(Z&-w,/rA(-
IS USE: PRIMARY❑ SEASONAL[]' NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole Bldg) YES(Part/sjofBldg)❑ NO❑
DESCRIBE WORK ?
SQUARE FOOTAGE:(proposed)
1ST FLOOR L W) sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK / sq.ft. COVERED DECCK sq.ft. STORAGE_ sq.ft. OTHER_,sq.ft.
GARAG—E7` s .ft ched'-'7/Detached❑ CARPORT sq.fL Attached❑ Detached❑
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MANUFACTURED OME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC❑ SEWER NEW❑ EXISTING❑
PLUMBING IN STRUCTURE? YES❑ NO❑ If yes,attach completed Water Adequacy Form
PERVAETER/FOUNDATION DRAINS PROPOSED? YES❑ NO[] EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS
OWNER acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.Admowledgement of such 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
COUNTY CODE 14.08.42) xx
Signature of OWNER(Musi6e sIgned*the WNER D to
DEPARTMENTAL REVIEW '-APPjtOVED DATE I DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT (1 --L
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH