HomeMy WebLinkAboutBLD2024-01249 - BLD CD Environmental Health Review - 10/23/2024 13�D2u24— O 129�I
Permi Vpl
MASON COUNTY KK CC
COMMUNITY DEVELOPMENT OCT 21 2024
�9
�WNC Permit ASSistance Center, Building,Planning 615 W. Akier8 tD
BUILDING PERMIT APPLICATION �o a
PROPERTYfN OWNER INFORMATION:
IIINFORMATION: CONTRACTOR INFORMATION: L
NAME: W TO/ NAME:fkuw plill, _
MAIL G ADDRESS:DRESS: ') D I CITY:MAIL ADDRESS: 0 E: —
CTTY: �'6Y1 STATE:1 � ZIP: CITY: h STATE:tM4 ZIP:
PHONE#1. 0- J -$1 PHONE:
PH0NE#2: 3(,0-82) -191 EMAIL :
EMAIL: Y1GlQlCY1RkiCLIM9/SU'tvJR,into_ L&I 017CI, 6 4Pr- a ExP.Lait
PRIMARY CONTACT: OWNER CONTRA EMOARI❑ OTHER� } WA OVM
NAME CITY `J'"tLLt[Nr STATE Yty_I ZIP q 'i; ".
MAILINGADDRESS O vi 1 LLR
PHONE �=%0'/•}Zla''Kl'DN CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 37bV-510-0101s ZONING
LEGAL DESCRIPTION(Abbreviated) QW eytiiT'I!r/ tt- 3r2 MABLK•.lLCTI: FItEDISTRICT S
SITE ADDRESS aoo EE PA*-%O VaA'ew-- farL
DIRECTIONS TO SIT,ADDRESS 3
ISM PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NO SNOW LOAD:_ps(
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Checka/i LI W a iy):QA
SALTWATER❑ LAKE❑ FIVER)CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW)k ADDITION❑ ALTERATION❑ REPAIR❑ OTHER []—
USE OF STRUCTURE(Read=,,Gor^8r•Cemmerctal&&ErcJ Q!d Als-li
IS USE: PRIMARY SEASONAL[INUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(0"n Bldg)[IYES(lmt(a1 OrBld�❑ NO
HEATED
DESCRIBE WORK N �ry
S UARE FOOTAGE: (stun—dl
ISTIST FLOO� 2ND FLOOR��sq.ft. 3RD FLOOR��s9.& BASEMENT � A . ft.
DECK sq.ft. COVERED DECK sq.ft. STORAGE, 0_sq.ft. OTHER sq.ft.
rENVIRONMENTAL
�sq.ft. Attached❑ Detached❑ CARPORT sq.ft. Attached❑ Detached❑
RED HOME INFORMATION: NIp a4 COPIES OF THE FLOOR PLAN REQUIRED"
MODEL YEAR LENGTH
BEDROOMS BATHS SERIAL NUMBER
HEALTH: ( W 11 Ex1sTBVG❑
R SOURCE: SEPTIC SEWER❑PLUMBTRUCTURE? YESA NO[I Ifyeu,artachcomp(eted Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NO
EXISTING SQ.FT.
EXISTING BEDROOMS /YA PROPOSED BEDROOMS J TOTAL BEDROOMS—
_�.__
OWNER acknowledges that submission of inaccurate Information may result Ina stop work order or permit revocation.AcknovAedgement of such is by
signature below.I declare that I am the treater and I further declare that I am entitled to receive this permit and to do lire work as proposed.I have
obtained permission from all the rrecessary parties,Including any easement holder or parties of Interest regarding this project The water or legal
representative,represents that the Information provitled b accurate and grant$employees of Mason County access to the stave described property
and i or ermest)rocl rem"
and
inspection,
This
permi
suspended for ofppti days.becomes null b.veld if work or authorized construction la Trot commenced within tag
day
if
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 42 E APPLICATION TO BE EXPIRED.(MASON
COUNTY
Date
Signature at vinmcm(Mla[tie slunau uv uo....•..-,
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTESICONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL II r
PUBLIC HEALTH 1
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