HomeMy WebLinkAboutBLD2024-01274 Replace Dock available pgs - BLD Application - 2/9/2025 Permit No: ������•� • ���'���
MASON COUNTY
COMMUNITY DEVELOPMENT
Permit Assistance Center,Building,Planning
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:0 v,.Lk f F= M.1 I C,r• NAME:
MAILING ADDRESS:70 t.Da ba Q , MAILING ADDRESS:
CITY: S�CL 14q r, STATE:WWAI, ZIP:_ 4- CITY: STATE: ZIP:
PHONE#1: O Z6 r 7 PHONE: CELL:
PHONE#2: 229•-032 - EMAIL
EMAIL: i '4-k "7 7 1. r L&I PEG# EXP. / /_
PRIMARY CONTACT: y OWNER CONTRACTOR❑ OTHER❑
NAME 1 EMAIL Ccl�GSYnf, a771�6��P'�Q��eC17M
MAILINGADDR SS `7 bolt CITY L,rr ,►{�n_STATE WA ZIPg�4'
PHONE k3W Zlo-Z307 CELL (.360)ZZ9•-0-142-7
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number)2-7 W 7 S I" 000 Z b ZONING 1z tT���I
LEGAL DESCRIPTION(Abbreviated)—]jMj3 E IZLA'Jr #8'T7Z'Z6 S 4-I/f 9Q FIRE DISTRICT 5-
SITE ADDRESS"7116_'0d6pb P-J CITY s 2I +,On _
DIRECTIONS TO SITE ADDRESS1fc+r✓-I,
I�G�-c��r.irz.5tcr�r 'i:�.•�. IGL,1•cti- C i'.�,ba�-lakt.t7r iu rn la_�•�a F is bo}� �d, rF ��2 tr���•�
IS THE PROJECT WITHIN 300 FT OF SLOPE(s)GREATER THAN 14%: YES❑ NO5r 1SNOW LOAD:_psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE K RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW❑ ADDITION❑ ALTERATION❑ REPAIR❑ OTHER Oel3l O.Ce.
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.J !)�k
IS USE: PRIMARY❑ SEASONAL Rr NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole Bldg)❑ YES(Part[s)of Bldg)❑ NO Ir
DESCRIBE WORK
SQUARE FOOTAGE: (proposed)
1 ST FLOOR sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK 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 SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC❑ SEWER❑ / NEW❑ EXISTING❑
PLUMBING IN STRUCTURE? YES❑ NO❑ tfyes,attach completed Water Adequacy form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NO[] EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS
OWNER acknowledges that submission of inaccurate information may 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 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 pernitlapplication becomes null&void if work or authorized construction is not commenced within 180
days or K construction work is suspended for a period of 180 days.
TINUATION OF RMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
APPLICATION OF 1811� AUSE THE APPLICATION TO BE EXPIRED.(MASON
OD 4.08.42)
ICi2 -4 ;-4
ignature I Date
DEPARTMENTAL REVIEW APPROVED ;,DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL �—
PUBLIC __--