HomeMy WebLinkAboutCOM2025-00025 Deck Addition - COM Application - 3/25/2025 MASON COUNTY Permit No: `ew;w� -
COMMUNITY DEVELOPMENT
NtC Permit Assistance Center, Building,Planning
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: Afa ; h r,1 n r h 11UNor LL G NAME: C>',,4 ffjZ
MAILING ADDRESS:-Eo 00,AI Z q _ MAILING ADDRESS:
CITY: y,Ig or4- STATE:&j A ZIP:q gSq CITY: STATE: ZIP:
PHONE#1:_ Zoir PHONE: CELL:
PHONE#2: EMAIL:
EMAIL: purl S 3361he-e-tan L&I REG# EXP.
PRIMARY CONTACT: OWNER g CONTRACTOR❑ OTHER❑
NAME Gkkv -�oQ2�t EMAIL D►6z1��ZcNuc1LC' c9�T( oolL • cowl
MAILINGADDRESS_ P.O. VLCSY, tt� CITY I,-IoO CA612T STATE \4tI r- ZIP y4v
PHONE CELL_206 41 ci -$G 8 S
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 4 Z 212 'S D Co O I ZONING R C-3
LEGAL DESCRIPTION(Abbreviated) bLoe-IC Co Or i`elc R E FIRE DISTRICT
SITE ADDRESS 2 4 1 t0 N- U S. I`I W J L C)I CITY K06txg P60-1
DIRECTIONS TO SITE ADDRESS Gt4 U S. 14*.%A%-1 tot i EA%I GF Gpx.. S7Ddtd+4
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES(I NO❑ SNOW LOAD:2_psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (check all that app,v):
SALTWATER® LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW❑ ADDITION'A ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence.Garage,Commercial Bldg,Etc.) L01A'\�'\GiZC f A L
IS USE: PRIMARY❑ SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(x%ole Bldg)❑ YES(,Part[s)of8idg)❑ NO '
DESCRIBE WORK V d:1-L< h b b%-t t c,4
SQUARE FOOTAGE:(proposed)
1ST FL sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK I•Lo 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*
MODEL �LENG�TH
6 7DTH�� BEDROOMS BATH��YEAR.
E
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC SEWER❑ / NEW❑ EXISTING
PLUMBING IN STRUCTURE? YES❑ NO IB Ifyes,attach completed Water Adequacy Form
V PERIMETERNOUNDATION DRAINS PROPOSED? YES❑ NO ff EXISTING SQ.FT.
�(V 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 permit/application becomes null&void if work or authorized construction is not commenced within 180
days or if construction work is�su or a period of 180 days.
PR F OF CON UAN TION OOF� RMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
`3 ERMIT APPLICATION OF 180 AYS OF MORE W CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY C E 14.08.42)
X
Signature of OWNER(Must be signed by the OWNER) Date
NDE,PARMEN REVIEW APE! D DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTM
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH