HomeMy WebLinkAboutBLD2024-01462 - BLD CD Environmental Health Review - 12/13/2024 MASON COUNTY Permit No: II It'i ' -
COMMUNITY DEVELOPMN6%VED
Permit Assistance Center, Building,Planning DEC 12 20
BUILDING PERMIT APPLICATION a
645 W.
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
HIUne Home.
NAME: 4R $js�.n.4 'W A}' NAME: tiaoe&2ND AVEE
MAILING ADDRESS:530 E LJ dd L+1 MAILING ADDRESS:
CITY:11ni M/1 STATE:_imA 2IP:gR994 CITY:_Puy.ILP STATE:'NA ZIP:ae&ts
PHONE#I: 51PO-00-(o214 PHONE:253840 t1 ^s CELL:
PHONE#2:,36D- Cpy9- �$0$ EMAIL :Pre- rst ucltxuglh nelwmeanom
EMAIL:Rah C3�kLt.xr1• � C�m�fl . LetH L&1 REG#HILINH•isg�a EXP. 4 /1326
PRIMARY CONTACT: OWNER® CONTRACTOR OTHER❑ 1
NAME 0.61t � -� EMAIL GSA ni'{• G�OWIAII • CBrn
MAILING ADDRESS CITY5 nMIY STATE WAWA Z-pQ
PHONE CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 32OZ I$jp021) .F ZONING
LEGAL DESCRIPTION(Abbreviated)5'hbt2,[n4 3r4 ADO '1i1k2 la•}t8 FIRE DISTRICT
SITEADDRESS Jr{'nr I.tYmL_I LV1 CITY Shelton
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO❑ SNOW LOAD:'Qpsf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all thatapply):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF ❑ STREAM ❑
TYPE OF WORK: NEW$ ADDITION ❑ ALTERATION ❑ REPAIR❑ OTHER [IUSE OF STRUCTURE(Eemdema,Garage,Commercial slag.E10 ! ASIAOn Cy
IS USE: PRIMARY SEASONAL ❑ NUMBER OF BEDROOMS ?-_ NUMBER OF BATHROOMS?,
HEATED STRUCTURE? YES(Whole8WIg YES(Panysigl8ldg) ❑ NO[]
DESCRIBE WORKAIsr.s fnn�• e+;cn
SOUARE FOOTAGE: (yropo.ed)
1ST FLOOR S44n sq. ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK__U5_sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft. Attached❑ Detached❑ CARPORT sq.ft. Attached❑ Detached❑
MANUFACTU +4 COPIES OF THE FLOOR PLAN REQUIRED+
MAKE MODEL LENGTH
TH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGEISEWER SOURCE: SEPTIC SEWER❑ / NEW EXISTING
PLUMBING IN STRUCTURE? YES IQ NO❑ Ifyes, attach completed Water Adequacy Form
PERIMETERNOUNDATION DRAINS PROPOSED? YES 0(, NOS EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS_ L TOTAL BEDROOMS Z _
OWNER acknowledges that submission of Inaccurate InMaoation may result in a stop work order or permit revocation.Acknowledgement of such is by
signature below.I declare that I am me 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 Meson 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 8 construction wark is suspended for a period of 180 days.
PROOF OF CONTINUAIMN OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT A TI F -DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
X �Zo2y--
Signa M s be signed by the OWNER to
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL L/
PUBLIC HEALTH
3tn2az�-ot�m�t f
ti
q
O B N N N le HI
Oj
FRONT Q g N c
on & s
_ O- e
3 m
m m
42 mil � a 0
N
Ur
Q =
DiWn py
oCD o= 0
V
iB
w
r
;hgh 6
5 e C
2 i A
6 0
�E
� � e
REAR
M @ PLN Approved
Cornea 12/13/2024
Meson County Community Development
Gavin Scouten
All Changes Subject to Approval
11409lmgs
Mason County soeo not require suMy4 kr
buiMlnp.Asa re 0 site Wane may not rMlect
accurate Eats.a Is me applicanfs responsibility
to comply with setack rsqulrementS.