HomeMy WebLinkAboutBLD2025-00151 - BLD CD Environmental Health Review - 1/6/2025 -
+ PROPERTY OWNER INFORMATION: CONTRACTORINFORMAT19RECEIVL
NAME:•EYCE a AMES CROSBY,LLC NAME:JIM MY(PRISTINE X n) 10
MAILING ADDRESS:M+'s PluaeCRY RE SW MAILING ADDRESS:an as vaaws DR T Q
CITY:we— STATE:wR ZIP:sa m CITY:PERT DNCHRRD STATE:w"
PHONE#I:NNN6eaa3a PHONE:Ewr 874 iM CELL:
PHONE#2: EMAIL ;J.,Yn1 mwoovasou,mw
EMAIL:GTHERIME.MIXONNEI16ecMEIST_NET L&I REG# EXP.
PRIMARY CONTACT: OWNER❑ CONTRACTOR❑ OTHER❑ ARCHITECT q �
NAME Iamz nmirammwM EMAIL aswmEesa4ecmJ •�
MAILINGADDRESS n+z PoNee"'mE+M CITY O 000sOn STATE "•" IP ae3ns 10j
PHONE I'smeemS CELL f
PARCEL INFORMATION: FEgT
PARCEL NUM13ER(12 Digit Number) uln zaaarJD ZONING"� S
LEGAL DESCRIPTION(Abbreviated) TR3oF oovrto*aaa TRzeaEsaazasz4e,Sao+as FIRE DISTRI C
SITE ADDRESS 13I E XRRBBExHaT RD CITY°weEmaw
DIRECTIONS TO SITE ADDRESS FRCMeHE1T0N,RTE3NORhN RIGHT )NIRIMMENHOFTRORIGHTCNEKIR ENXCir RDTOSRE
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: (CheckaBrhmapPN):
SALTWATER❑+ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM ❑
TYPE OF WORK: NEW ❑+ ADDITION❑ ALTERATION ❑ REPAIR❑ OTHER ❑' REPIRCEMENT 1R°wTION
USE OF STRUCTURE(Butdo ce,Garage,Commercial Bldg,EC)SINGLE F MILY RESIDEXos
IS USE: PRIMARY ❑ SEASONAL ❑' NUMBER OF BEDROOMS' NUMBER OF BATHROOMS°
HEATED STRUCTURE? YES(whole Bldgl ❑e YES(Pants)DfBvW❑ NO❑
. DESCRIBE WGRK REMOVEEXISTNG eFR RND CCNSTTIWTNEW eFR IX yME FCpiPRMT.UGNT wood FRRNE TYPE YH
SOUARE FOOTAGE: (pmyarad)
I ST FLOOR',0b0 sq.ft. 2ND FLOOR ES' sq.ft. 3RD FLOOR' sq. ft. BASEMENT° sq.ft.
DECK' sq. ft COVERED DECK"' sq.ft. STORAGE° sq.ft. OTHER sq.ft. a„
GARAGE' sq.ft. Attached❑ Detached❑ CARPORT a sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: •4 COPIES OF THE FLOOR PLA==RFQUIRED-
MAKE w" MODEL w" YEAR NI" LENGTWIDTH wABEDROOMS WABATHS w" SERIAL NUMBER NA '
ENVIRONMENTAL HEALTH:
SEWAGEISEWER SOURCE: SEPTIC ❑ SEWER❑+ / NEW EXISTING❑+
PLUMBING IN STRUCTURE? YES ❑' NO❑ Ifyes, attach completed Water Adequacy Form
PERIMETERIFOUNDATION DRAINS PROPOSED? YES E+ NOD EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS 3
OWNER acknowledges that Submission of inamorata information mey result in a stop work order or permit revocation.Acknowledgement of such is by
signature below.I declare that I am the owner and I further declare Mat 1 am endded tD 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 pried. The SMI or legal
representative,represents that the information provided is amcurate and grants employees of Mason County access to the above deacri bad property
and structure(s)for review,and inspection. This pemlb/application becomes null&void R work or authorized construction is not manmenced within 180
days or If construction work is Suspended for a period of 180 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT 1 PPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED. (MASON COUNTY CODE 14.08.42) 49 _
Signature of OWNER(M at be siunetl by the OWNER)
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