HomeMy WebLinkAboutBLD2024-01354 - BLD CD Environmental Health Review - 11/13/2024 BLP?al -DI3sq
ENVIRONMENTAL
MASON COUNTY Permit No:3"NfAw
COMMUNITY DEVELOPMENfECEIVED
Permit Assistance Center, Building,Planning NOV 13
BUILDING PERMIT APPLICATION 61 i W. Al Skeet 1
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: J
�
NAME:Rolnd a Ter—e"mwk� NAME:MS Gen"ccnbasaa uc �01
MAR.ING ADDRESS:40701 NEtlMM MAILING ADDRESS:P 09aa+w+ O
CITY:BNhel STATE:WA ZIP.ewtt CITY:N4o,%nwt STATE;WA ZIP:wesla
PHONE#I:wslaeeTM PHONE: CELL; marasaw
PHONEQ:Qsstsmsa EMAR.:- Wrcmlwna.n.mn
EMAIL:N'"'""*t°a°"'°"°'" L&I REG#wtsceocateez EXP.�9
PRU4ARY CONTACT: OWNER❑ CONTRACTOR El OTHER
NAME "o-aa" EMAIL moamkomwetwm
MAILINGADDRESS POeoa1M1 CITY X0°bood STATE WA ZIP A0518
PHONE CELL mesneNe
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) N215510 l 7ANIN0 QRJ
LEGAL DESCRIPTION(Abbreriated) +^N (AA3WAN*10TR144e5sr0 FIRE DISTRICT Ng
SITE ADDRESS 121 N I(alones Bad CITY Nowepon
DIRECTIONS TO STTE ADDRESS +'�t1w w waerwse row MnMm m talmnea rage rosvw ro xos.ree elfin care xpdakem baron a nw on Nn
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESQ NO E] SNOW LOAD: psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: fchntan nrmappry):
SALTWATER❑ LAKE D RIVER/CREEK D POND 0 WETLAND D SEASONAL RUNOFF D STREAM
TYPE OF WORK: NEW❑ ADDITION El ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(aesidenre.Lampe,Ca emenial aldg.ear.)RB0wM1e
IS USE: PRIMARY D SEASONAL Q+ NUMBER OF BEDROOMS_ NUMBER OF BATHROOM$_
HEATED STRUCTURE? YES(Whale emp10 YES fPnnlrl or del❑ NO
DESCRIBE WORK yenta admxon ro esNeng akumse
SQUARE FOOTAGE: rpropxed)
1ST FLOOR eta sq.ft 2ND FLOOR_sq,A. 3RD FLOOR_sq.ft. BASEMENT_sq.ft
DECK 100 sq.R COVERED DECK-0 sq.ft. STORAGE sq.ft. OTHER_sq.ft _
GARAGE_sq,ft, Attached❑ Detached❑ CARPORT sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: e4 COPIES OF THE FLOOR PLAN REQULREDa
MAKE MODEL YEAR LENGTH
WIDTH_ BEDROOMS BATHS SERIAL NUMBER
ENMONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC Q+ SEWER / NEW D EXISTING Q+
PLUMBING IN STRUCTURE? YES 0' NOD If yes,attach cornpleted Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES NOB EXISTING SQ.FT.
EXISTING BEDROOMS 1 PROPOSED BEDROOMS a TOTAL BEDROOMS 1
OWNER acknoWedgm Met sudnfaslan or mama.,,inlormwlon may result In a stop oak order or permit revocation.Acknowledgement of such u by
Signature below.I declare Mat I am Me owner awl i More,dealers Mat I am andoled re receNe this permit and to do the wade as proposed.I have
obtained permission from all to necessary padow,incurs,any easement Muter or pandas of imemet dMon ing thu project. The owner or legal
representative,represents Mat the information provided is accurate add grans employees of Mewn Cwnty access to Me al,dm described properly
and seucwre(s)for review and inapmdion. This pamWapplicaeon Mmmes null&void it work or autMxzed mnstmdipr is not commenced whin 180
days or g construction work Is suspended for a panad 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
COU C DE 14.08.42)
Signature M OWNER(Mum be signed by the OWN 6 1� Date
DEPARTMENTAL REVIEW APPROVED DATE I DENIED DATE TAGSMOTES/CONDTTIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH
BLD2024-01354
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PLANNING SETBACKS
Setbacks measured from
ro'u�xve/+ias sm.xn ax.oxl farthest projection of structure
' A`°°°"`"' xe>.ess Front:25'
YV�E�.r/y Side:5'ADV2024-00158
xxx sdlrsrosaAaauxu 'Subject to EH Setback;
SM PLAN
OWNER: Bob a Ten Brunswkk
ADDRESS: 191 N Kokanee OW AemAs mxmxuesur
Hootlsgxt Washington 98548 :mmurxx
PHONE: 4 0%..
}ulx: Mi
APPROVED
v� MASON COUNTY DCD PLANNING
SITE PI-AN REQUIRED TO BE ON SITE
CHANGES SUBJECT TO APPROVAL
By: /` "'"'7' Dw: 01/22/2025
Disclaimer:
Mason County does not require a survey to obtain a
building permit.As a result, site plans may not reflect
accurate data. It is the applicant's responsibility to
comply with setback requirements.
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