HomeMy WebLinkAboutBLD2025-00373 - BLD CD Environmental Health Review - 4/20/2025 -- Permit No: I/ l� VW ' W ��f
.v.._ `. MASON COUNTY
i COMMUNITY DEVELOPMENT
.- Permit Assistance Center,Building,Planning
BUILDING PERMIT APPLICATION RECEIVED
s PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
of NAME: OHN 77-(ornA s M C MA,J OS NAME: MAR 2 8 2025
—}.. MAILING ADDRESS:7 I ',Jr Qu(f N •ruto DR MAILING ADDRESS:
CITY:13ELFfl STATE: kM ZIP:gSSZ ' CITY: STATE 4�P
PHONE 'Z16 ' '].22 PHONE: CEb VV. AtcterStreet
PHONE#2: EMAIL:
W EMAIL: L&I REG# EXP._/ /
PRIMARY CONTACT: OWNER® CONTRACTOR❑ OTHER 0
iNAME 30140 MLMAOOS EMAIL -OHI&)e MCMAQ06• 4/2061`141L.Or1
MAILING ADDRESS rT 1 to G2t)a(El- A'.twl DQl&E CITY SfL FA r 7 STATE tA'/) ZIP cfe52 e
,) PHONE CELL 22i'6 --2I6`'72205
PARCEL INFORMATION: �j ,`/1 !�!� _
>_ 4 PARCEL NUMBER(12 Digit Number) 2�( f UU c'} ZONING I11�i M�
LEGAL DESCRIPTION(Abbreviated) T� i 0 +�t- c -1 I FIRE DISTRICT C 'D l
`I- SITE ADDRESS 7(OE 00E6" q,✓N 7Z1� CITY 3E1-64 _
,,,
DIRECTIONS TO SITE ADDRESS lAM 11 t.)UT�r14 SHO P6.R T 0.-, CAN/U"t Z I�. RT crs ;OE NJRD RD APR 0 2 2015 _
k LF vp NE c 5H41 ASS R . LC or.J $Z ARRI�G,E Kr 0,1 Kea,vSHA RI) IF c r-i r'FQi, JA
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%/a: YES❑ NO 0 SNOW LOAD: z.osf RECEIVED
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER 0 LAKE 0 RIVER/CREEK❑ POND 0 WETLAND 0 SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW® ADDITION 0 ALTERATION 0 REPAIR 0 OTHER 0
USE OF STRUCTURE(Residence,Garage.Commercial Bldg.Etc.) RES It)CIJC6
IS USE: PRIMARY® SEASONAL 0 NUMBER OF BEDROOMS 2 NUMBER OF BATHROOMS I
HEATED STRUCTURE? YES(Whole Bldg)0 YES(Pail(s)of Bldg)® NO 0
DESCRIBE WORK COO S R0C 7 ►JEI.J 'H0v- E Tj TOTAL 5QF tkipr IS Coticzci)Rj V-/
SOUARE FOOTAGE:(propose)
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1ST FLOOR_ -I i I sq.ft. 2ND FLOOR 0 sq.ft. 3RD FLOOR if2 sq.ft. BASEMENT 0 sq.ft
DECK 6. sq.ft COVERED DECK 16-V.sq.ft. STORAGE Q5 sq.ft. OTHER 525 sq.ft
GARAGE 0 sq.ft. Attached 0 Detached 0 CARPORT QS sq.ft. Attached 0 Detached 0
MANUFACTURED H RMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
1
TH BEDROOMS BATHS
ENVIRONMENTAL HEALTH: tAt9A_ 0 $ S
SEWAGE/SEWER SOURCE: SEPTIC® SEWER 0 / NEW 0 EXISTING 0
PLUMBING IN STRUCTURE? YES® NO 0 If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NO® EXISTING SQ.FT.
EXISTING BEDROOMS ." PROPOSED BEDROOMS a TOTAL BEDROOMS
OWNER acknowledges that submission of inaccurate Information may result in a stop work order or pent revocation.Acknowledgement of such is by
signature below.I dedare 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 structures)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 suspended for a period of 180 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERM PLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
X li ? U29SS
Signature of OW (Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH f2d 1 titiltfrt5-..
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