HomeMy WebLinkAboutbld2025-00219 - BLD CD Environmental Health Review - 2/27/2025 Permit No:
MASON COUNTY
COMMUNITY DEVELOPMENT
aermRAUl:omce Core[Bammnc Plannirq
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAM lyalas FM.'IaydaebTnynbee NAM.IE:Fm Neetl Conanuadawn
MAILING ADDRESS:B3t 1 Ol A On NE MAILING ADDRESS:1091 SE Crap Rtl
CITY:010nPia STATE:WA ZIP;mstB CFFy:SbNwn STATE:WA ZIP:BSiMa
PHONE#1:3BOa 01? PHONE:300ar0 tzm CELL:
PHONE#2: EMAIL:rrao're@rod cnnsuuean—
EMAIL00JOlNeutl— L&I REG#FCXIIENCBa3K EXP.05/21/
PRIMARY CONTACT: OWNER[] CONTRACTOR[I OTHER❑ �^
NAME%--- EMAIL
MAIUNGADDRESS CITY STATE_ZIP :4eC,
PHONE CELL �PARCEL INFORMATION: TipsPARCEL NUMBER(12 Digit Numbm)P3t3a5oa0atB ZONING
LEGAL DESCRIPTION(Abbreviocd)'^®"°"°`^"^`^°^^®""••""m` FIRE DISTRICTS
SITE ADDRESS 101 E Community Gn Rtl CITYSnaMm
DIRECTIONS TO SITE ADDRESS NaM m HWY 3.East m E PiGeriip Fall,Emaw E Cwnmuniry,Club Rd End at 101 E Cwnmuniry Club
MTHEPROJECTWI'I'IIIN3WO OFSLOPE(S)GRF.ATERTHANIO'A: YES[] NO[] SNOWLOAD:IS paf
LNPROPERTYWITHIN20FTOFTHEFOLIAWING: (chrctdtMm opgyl:
SALTWATERQ LAKE❑ RIVER/CKEEK❑ POND❑ WETLAND❑ SEASONALRUNOFF❑ STREAM[]
TYPE OF WORK: NEW E ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE tang,.caammv Bdg,Ew.)0e'�tl+'r ORWe
ISUSE: PRIMARY❑ SEASONAL[] NUMBEROFBEDRCOMV NUMBER OF BATHROOMS
HEATED STRUC UU? YES(tpedasmy❑ YES OWV� emy❑ NO E]
DESCRIBE WORKNex iswhore eancnas Pampa.
SOUARE FOOTAGE:(P,no)
IST FLOOR eq.ft. 2ND FLOOR sq.R 3RD FLOOR sq.a. BASEMENT aq.ft.
DECK so.ft. COVERED DECK s,.11 STORAGE sq.& OMER al.ft.
GARAGE371 sq.ft. Attached[] DewcheC[]i CARPORT oq.A. .laached[] DewchaD
MANUFACTURED HOME INFORMATION: aA COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERLV.NUMBER
ENVIRONMENTAL HEALTH:
SEWAGEISEWER SOURCE: SEPTIC El SEWER[] / NEW EXISTING[]
PLUMBINGINSTRUCTURE? YESQ NO byes.armd ,,Wlnred Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NO[] EXISTING SQ.FT.91
EXISTINGBEDRUOMS 3 PROPOSED BEDROOMS o TOTALBEDROOMS 3
OWNER wimmoalgs tlatsmamamn d Inaccurale Imomiallm may nail in a sIW myk w w n- tre mtiun.MknPNVJgMnMI MWWie by
siJ xebeb+:.ldWam MNIamtbewmeradINMer EedammatIamwuill torec NlsNmltandto Eo New aspmp .lhero
WIMM ii—i,im man Y me wyannary games,an dim,any easement mic erorpanies of Interest regadmg Nis pqM,The WMra,lyal
RPeaambtive,BpresM tlMInfmm MAdn IeecmmwaMFan6anpleY dMasonC ntyamassbNeabo dma Vgft
and
abu mmiI(areuiex"impedian.rna pemiiWppliW40n lretom69 nuu avna nwmk or ouWnssE mnsW Nm anM eonanacen whin IW
my mXwrotludmw eao a,trodPenW0l1Wdays.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
LIC F 180 DAYW MORE WILL CAUSE THE APPLICATION TO HE EXPIRED.(MASON
COUNTY CODE 14.08.42)
X 1�24�25
gnaWre of OWNER sinned by the OWNER) Date
DEPARTMENTAL REVIE APPROVED DATE DENIED DATE TAGSMOTES/CONDITIONS'
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
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PUBLICHEALTH
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DESIGN BY: FIELD RESIDENCE
ADA" L. 101 E COMMUNITY CLUB RD
vQn0z5 SHELTON, WA 98584 ADAM LANEER DESIGN y