HomeMy WebLinkAboutBLD2024-01350 SFR - BLD Application - 11/12/2024 Permit No: �-► .Q JS�
MASON COUNTY R E C Ntu
COMMUNITY DEVELOP ENT e
Permit Assistance Center,Building,Planning NOV 2024
0 BUILDING PERMIT APPLICATION W. Alder Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:-5a'� NAME:
MAILING ADDRESS:146910 a Mvj MAILING ADDRESS:
CITY: STATE:��ZIP: A51 CITY: STATE: ZIP: Z
PHONE#1:, b0 -BO -a4 6o PHONE: CELL:
PHONE#2: EMAIL:
EMAIL:61ueLli L&I REG# EXP.
PRIMARY CONTACT: OWNER❑ CONTRACTOR❑ OTHE�R
NAME WA+AeL 1.090MiA ) EMAIL&a IL_A hw Gk• u�rt
MAILING ADDRES Za b —MIPM OO ST R C�2 CITY &E c1dAL nTATE/wI+OL ZIP
PHONEc36d' 7116-42,13 CELL
PARCEL INFORMATION: A
PARCEL NUMBER(12 Digit Number) ; /� o —5) -IMG0 1 ZONING L)6*- l!Z
LEGAL DESCRIPTION(Abbreviated) ALL`/1J &V— _M LOT 4 FIRE DISTRICT
SITE ADDRESS CITY
DIRECTIONS TO SITE ADDRESS "SAn "CU WADE ST — —VUQJJ IL OAJ
�►�LV�J A47 Li+11 L61- ON LIeVIr
IS THE PROJECT WITHIN 300 FT OF SLOPES)GREATER THAN 14%: YES[] NO;K SNOW LOAD:-3-0—psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apple):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEIVX ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.
IS USE: PRIMARY SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS t
HEATED STRUCTURE? YES(WholeBldgl YES(Part[s]ofBldg)❑ NO❑
DESCRIBEWORKP'I&2 z— P Z•-S��/ S -
SOUARE FOOTAGE:(proposed)
I ST FLOORJ2!G sq.ft. 2ND FLOORS sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK_ oA 0 sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE 00 sq.ft. Attached KDetched❑ 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❑ If yes,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 permittapplication becomes null&void if work or authorized construction is not commenced 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 APPLICATION 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