HomeMy WebLinkAboutBLD2024-00330 SFR - BLD Application - 3/6/2024 MASON COUNTY Permit
COMMUNITY DEVM-]�OPMENT _ 6
Permit Assistance Center,Building,Planning MAR 2U24
BUILDING PERMIT APPLICATION 615 W. Alder Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: /CIF!!"L 4 L.L S 8--1E,5!- NAME: 1,12A
MAILING ADDRESS: '�3 fa0 3Ah o,4 AD MAILING ADDRESS:
CITY: AC-77),11 STATE: CA - ZIP:g M p CITY: STATE: ZIP:
PHONE#1:lb,b 11910.- 0 7,71 PHONE: CELL:
PHONE#2:6In I) 2'/D "FSS EMAIL:
EMAIL: gj 'S L 0--✓+-d L Co Nl L&I REG# EXP.
PRIMARY CONTACT: OWNER®' CONTRACTOR OTHER[]
NAME - S L EMAIL KH�- I-G fta4.4)t�1
MAILING ADDRESS 33 op -,WSurii 4 - CITY AC70%J STATES ZIP 3S1G
PHONE(6/() 8/Q-n 77q3 CELL(io61t/Y/Q • t`t 1'9
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) Z z z Z 3 ^Sty O/b Z Z ZONING
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT
SITE ADDRESS 7,S1 � ZAA, .L1-5 EAJ.l�l" APIL vE CITY 66LJF:-�2
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NO®' SNOW LOAD:_psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Checkan that apply):
SALTWATER❑ LAKE tr RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW M ADDITION❑ ALTERATION❑ REPAIR[I OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc. /LE$Sn 95"k c
IS USE: PRIMARY® SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS 2-
HEATED STRUCTURE? YES(Whole Bldg)I@ YES(Part(sI of Bldg)❑ NO❑
DESCRIBE WORK COAL 5TP 0 r T A- V ;I--sz A/ Si'T L E /5 �i 1-1-6 JAC
SQUARE FOOTAGE:(proposed)
1ST FLOOR✓b 7-3 sq.ft. 2ND FLOOR 2 b sq.ft. 3RD FLOOR JO' sq.R BASEMENT O-- sq.ft.
DECK -'�r sq.ft. COVERED DECK q Z ? sq.ft. STORAGE AFY— sq.ft. OTHERS sq.ft.
GARAGE ,,e�r` sq.ft. Attached❑ Detached❑ CARPORT AO sq.ft. Attached❑ Detached[]
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE ,[-(/A- MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC SEWER❑ / NEW® EXISTING❑
PLUMBING IN STRUCTURE? YES® NO❑ Ijyes,attach completed Water Adequacy Form
PERRYIETERNOUNDATION DRAINS PROPOSED? YES❑ NO[] EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS L TOTAL BEDROOMS 2—
OWNER acknowledges that submission of inaccurate information may result in a stop work orderorpermit 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
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 8 void if work or authorized construction is not commenced within 180
days or if construction work is suspended for a period of 1 BO 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)
natur 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