HomeMy WebLinkAboutBLD2024-01075 SFR - BLD Application - 9/4/2024 ALA,Miiiiffn�0—
MASON COUNTY Permit No: BLD7 07A p,F5
COMMUNITY DEVELOPMENi EIVED
Permit Assistance Center, Building,Planning P 4 2M
BUILDING PERMIT APPLICATION 615 W.Alder StrAD
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:-S��(Aala;6&2 P���1 IzD NAME: ,
MAILING ADDRESS: 141111',:57 MAILING AD RESS:
CITY: lftc� STATE: _ZIP: CITY: STATE: ZIP:
PHONE#I: 3',n (4n a- PHONE: CELL:
PHONE#2: EMAIL
EMAIL: L&I REG# YO -) "") EXP. /
PRIMARYCONTACT: OWNER CONTRACTOR❑ OTHER❑
NAME EMAI
MAILING ADDRESS CITY ' STATE _ ZIP SD
PHONE 3L"P)C/()" ri r��'� 'z LL_ e U
PARCEL INFORMATION: /1
PARCEL NUMBER(12 Digit Number) / �,j 6t� ZONING/
LEGAL DESCRIPTION(Abbreviated) 6 el .Sr FIRE DISTRICT
SITE ADDRESS %Y71 . (/ Wy CITY
DIRECTIONS TO SITE ADDRESS
� w C u ���6( ✓f f
v z�i (CZl /y 7/t? /U tJSr<o/loot/ /, i"u
i
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] Nq;g_ SNOW LOAD:-.1fpsf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that applv):
SALTWATER ❑ LAKE ❑ RIVER/CREEK❑ POND ❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM ❑
TYPE OF WORK: NEW , ADDITION ❑ ALTERATION ❑ REPAIR ❑ OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc. / P
IS USE: PRIMARY ❑ SEASONAL❑ NUMBER OF BEDROOMSA NUMBER OF BATHROOMS_
HEATED STRUCTURE? YES(Whole Bldg)0- YES(Part[s]of Bldg) ❑ NO ❑
DESCRIBE WORK
SQUARE FOOTAGE: (proposed)
1ST FLOOR y1 G`J sq. ft. 2ND FLOOR sq. ft. 3RD FLOOR sq. ft. BASEMENT sq. ft.
DECK sq. ft. COVERED DECK sq.ft. STORAGE sq. ft. OTHER sq. ft.
GARAGE sq. ft. Attached❑ Detached❑ CARPORT sq. ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE_6 o E y- ,t1 11,in e—s MODEL y3 Y?1 YEAR,, _ LENGTH
WIDTLl
H BEDROOMS BATHS a SERIAL NUMBER & Sin y>78 4;S
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC SEWER❑ / NEW ❑ EXISTING ❑
PLUMBING IN STRUCTURE? YESA NO ❑ Ifyes, attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES ❑ NO[J — 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.Acknowledgement 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
MOVtq