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Home My WebLink AboutBLD2025-00139 - BLD CD Environmental Health Review - 2/4/2025 ENVIRONMENTAL Nci HEALTH PerDlft BL�o2GY�` S-G171 -�I MASON COUNTY COMMUNITY DEVELOPMENT RECEIVED Permit Assistance Center,Building,Planning FEB 0 3 2025 BUILDING PERMIT APPLICATION 615 W.Alder PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: NAME: sh NAME: �Y MAILING ADDRESS: MAILING ADDRESS: jO1s. CITY: lP✓L—STATE:_�A—Z CITY: STATE: ZIP: PHONE#1: (�O %QQ—IP(rj'D PHONE: CELL: / PHONE#2: EMAIL: EMAIL: L&I REG# F.XP. PRIMARY CONTACT: OWNER CONTRACTOR❑ OTHER❑ NAME EMAIL MAILINGADDRESS CITY STATE_ ZIP PHONE CELL PARCEL INFORMATION: PARCEL NUMBER(12 Digit Number) 3231515=W TONING RR'5 LEGAL DESCRIPTION(Abbreviated) TR 8 OF SURVEY 13/240 FIRE DISTRICT SITE ADDRESS NE CAPSTAN ROCK ROAD CITY TAHUYA ref DIRECTIONS TO SITE ADDRESS NE MANKE ROAD TO NE CAPSTAN ROCK RD 1IV�MJ- IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESJ. NO❑ SNOW LOAD:2T_psf IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Checiattaawly): C-1EDa'1o24-0009V SALTWATER❑ LAKE❑ RIrV,,,/(ER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑ Lr TYPE OF WORK: NEW r ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑ USE OF STRUCTURE(geaW rase,Commercialtitht Ew.) 1121.C_JjAqCt IS USE: PRIMARY& SEASONAL D NUMBER OF BEDROOMS NUMBER OF BATHROOMS 2. HEATED STRUCTURE? YES(While Bldg)E�_YES(Partin/rg'sldg)❑ NO❑ DESCRIBE WORK f�I r.1/s( 12. SOUARE FOOTAGE: (pr a) 1 ST FLOOR J_sq.it. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft. DECK _ sq.ft. COVERED DECK_41S sq.ft. STORAGE sq.ft. OTHER sq.ft. GARAGE sq.ft. Attached❑ Detached❑ CARPORT sq.ft. Attached❑ Detached❑ MANUFACTURED HOME INFORMATION: `4 COPIES OF THE FLOOR PLAN REQUIRED- MAKE MODEL YEAR LENGTH WIDTH BEDROOMS BATHS SERLALNUMBE . ENVIRONMENTAL HEALTH: SEWAGE/SEWER SOURCE: SEPTIC', SEWER❑ / NEWV EXISTING PLUMBING IN STRUCTURE? YESO NO❑ Ifyea,attach completed Water Adequacy Form PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NOD EXISTINGSQ.FT. EXISTING BEDROOMS 0 PROPOSED BEDROOMS ___�_ TOTAL BEDROOMS OWNER acknowledges that submission of inaccurate Information may resuK in a stop wodc caterer PermR mwcabon.Acknowledgement of such is by slgnawre eaow. declare Met am me owner and wm»r declare Nat em en1i11e0 to recehre Nla pannn aM to ao Na woM es proposed.I have attained permission town all Me necessary PaNes,Inducing any easement holder or"dies of interest regadkg this project. The owner car legal representative,represents Nat Me Information pre nded is accurate and grants employees of Mason County access to the above described soperty and structures)for review and inspection. This permlaapplicabon becomes null 3 wid if vmnk or authorized construction is not oommenoad w it in IN days m 8 wns Con work b suspended fora period of 1B0 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) Signature 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 69 ZIZI 202 m® mvkn H • 8 | _ _- _� _ , G \ n _a m. �_ § . k . © » f ! — ] - - - - - - _ § . § - � t ! § f . : 2 g | f � ) | , Le) , ! % ! � { !�!$ ! } | .g , ! 3 ! ) / ! � § f ! � . ` \ ) / I § . > j � ) ( ) � § « !