HomeMy WebLinkAboutBLD2024-00324 - BLD CD Environmental Health Review - 4/12/2024 MASON COUNTY Permit No: 1—
COMMUNITY DEVELOPMENT
Permit Assistance Center, Building,Planning N E C i
BUILDING PERMIT APPLICATION MAR i i 9O�
PROPERTY OWNER INFORMATION: CONTRACTORINRARM4T x• SF 2j
NAME:Amer Khani&Lodann MoN NAME:Tao
MAILING ADDRESS:14211 Both Ave NE MAILING ADDRESS:
CITY:iaridand 'STATE:WA ap;ceo34 CITY:
PHONE#I:zee-recant PHONE: L
PHONE#2: EMAIL:
EMAIL: L&I REG# HE
PRIMARY CONTACT: OWNER❑ CONTRACTOR❑ OTHER 0
NAME EMAIL Pemate®eleveticam ov,
MAILING ADDRESS am awn A.sw sdtsA CITY Ny"up STATE WA ZIP M73
PHONE 086.6674371 CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 122171400070 ZONING RR5
LEGAL DESCRIPTION(Abbreviated) P G1-217-V-tw FIRE DISTRICT Dla nd 5
SITE ADDRESS B80 E NM g oay Rd. CITY Allyn
DIRECTIONS TO SITE ADDRESS East on W Alder 8l toward Nfiat at,at the on d;;'isa.the AW ran onto N rratd&e
Turn left onto WA,3 WE Pine St Continue straight onto E North Bey Rd.
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NO❑i SNOW LOAD:25 ps1
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (CheohoBthatapply):
SALTWATER O LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF[] STREAM❑
TYPE OF WORK: NEW +❑ ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Remus.,Garoga,C.mmrcblBldg,6a.)ReeWe00a
IS USE: PRIMARY 0 SEASONAL❑ NUMBER OF BEDROOMS 2 NUMBER OF BATHROOMS 2.25
HEATED STRUCTURE? YES/Whok Biala)❑i YES(Par7(m)oJBhdz)❑ NO❑
DESCRIBE WORK Construct.SFR with Attached Garage
SQUARE FOOTAGE: gaA.wp
IST FLOOR 13cg sq. ft. 2ND FLOOR 247 sq.ft. 3RD FLOOR sq.ft. BASEMENT 673 sq.ft.
DECK 473 sq.ft. COVEREDDECK260 sq.ft STORAGE 213 sq.it. OTHER sq.ft.
GARAGE W7 sq.ft. Attached I] Detached❑ CARPORT sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: e4 COPIES OF THE FLOOR PLAN REQUMEDe
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC❑ SEWER❑, / NEW❑e EXISTING❑
PLUMBING IN STRUCTURE? YES❑+ NO❑ Ijyes, attach completed Water Adequacy Form
PER]METER/FOUNDATION DRAINS PROPOSED? YES❑ NO[] EXISTING SQ.FT.
EXISTING BEDROOMS 0 PROPOSED BEDROOMS 2 TOTAL BEDROOMS 2
OWNER acknowledges that submission of Inaccurate information may resuft In a stop work order or permit revocation.Atlmowledgemera of inch is by
signature below.I declare that I am the owner and I further declare mat I am entitled to receive this pe"It 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 intonation provided Is accurate and grants employees of Mason County access to the above described property
and structure(s)for review and inspection. This permMapplication becomes null&void 8 work or authorized construction is not commenced within 180
days or if construction wodr 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)
X .'m-M_� Mar 7,2024
Signature of OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH 41 IZ.1 (
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