HomeMy WebLinkAboutBLD2025-00342 - BLD CD Environmental Health Review - 4/21/2025 ,�' ' 4:1 MASON COUNTY COMMUNITY SERVICES Permit No: e 3b�,5'"no- a
ks. PERMIT ASSISTANCE CENTER:
, , ("• �+ •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL E D
g. ,•i t- F •0 615 W.Alder Street Sheen,WA 98584 R E C E I V
"y Phone Sheifcn:(260)427-9570 ext 352•Fax:(360)427-7798 Phone
o` �y Beifaic(360)275-4467•Phone Elme:(360)482-5269 MAR g � 2 0 2025
BUILDING PERMIT APPLICATION c, 11An// ��
PROPERTY
OOWNER DiFORMATION: CONTRACTOR IN `�1L'�'TI(7V�er Street
NAME: •.%ICOR C s1£U 4tO►1 Li e NAME: JL/tW /1S7k4cion LLC'
MAILLNrG ADDRESS:aQ 1331ft sT-' MAILING ADDRESS:az•,'(/J E L
CITY:L a7)1IL2k2 STATE: W/}- ZIP: Q93IV CITY: '/a STATE: [✓.4 ZIP: f39O
PHONE#1: 2S3 ltXi6fi PHONE. {o CELL: )f3 r 6loy Cl‘....., `ks`
PHONE#2: 1 EMAIL:,30.4042 (/vt isi cfi //c et t0/N
EMAIL:__ C 2/?S 1 uc T1vn LlG L&I REG 4 y,fikezeez �7./q 1 E . It's
PRIMARY CONTACT: OW&t.IS CONTRACTOR❑ OTHER❑
NAME DOnii L�^ 1)C'k EMAIL�i<-OrP(DryS'2•fc#raa//<e h t,--1 •
MAILING ADDRESS 2O /? -7(`'f T E CITY ± STATE 4_.''4 ZIP /r,+'. /
PHONE o1S 104 61 CELL 5-3 --70q Zit,
PARCEL INFORMATION: �,7 ENVIRONMENTAL
PARCEL NUMBER(12 Digit Number) 3,2109- •SO — yv ZONING H EA LT H
1 LEGAL DESCRIPTION(Abbreviated)^ FIRE DISTRICT
ADDRESS a!J is it 41 i CITY orietr1
• ' DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YTS❑ NO 9 SNOW LOAD: psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (CheokeE that apply):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW Rt ADDITION❑ ALTERATION❑ REPAIR❑ OTTER ❑
USE OF STRUCTURE(Residence,Garage,Commeretal Bldg;Etc) i esI X(flce
IS USE: PRIMARY E SEASONAL❑ NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS
HEATED STRUCTURE? YES( :eteBldg)❑ YES(Part[s]of Bldg)
Q NO ill
DESCRIBE WORK Hail4 ' Q fr-1,2ed S/"g/t ?ha !70!!Se
SQUARE FOOTAGE:(propcse
1ST FLOOR i 61 7.sq.R 2ND FLOOR sq.ft. 3RD FLOOR sq.ft BASEMENT Sc.IL
DECK sq.ft COVERED DECK I 11 sq.ft. STORAGE sq.ft. OTHER sq.It.
GARAGE 5') sq.f. Atf'nhed❑ Detached❑ CARPORT sq.ft Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: • *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR I.F.NGTH
WIDTH BEDROOMS BATHS SERLALNUMBER
ENVIRONMENTAL Iili,ALTH:
SEWAGE/SEWER SOURCE: SEPTIC,g SEWER❑ / NEW k EXISTING 0
PLUMBING IN STRUCTURE? YES tg NO❑ byes,attach completed Water Adequacy Form
PERLIETER/FOUNDATION DRAINS PROPOSED? YESIg NO❑ EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 3 L./TOTAL BEDROOMS 3 L.--
OWNER acknowledges that submission of inaccurate infonration may result in a stop work order or permit revocetion.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 parses,including any easement holder or parries of interest regarding this project. The owner or legal
representative,represent that the information provided is accurate and grams employees of Mason County access to the above described property
and structure(s)for review and inspection.This permit/application beoames null&void if work or authorized construction is not commenced within 180
days or ff conssuon 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 APPLIC TION OF 180 DA S OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
X 03, ago, �1e,J.5"
Signature of OWNER( t b igned by the OWNER) Cate
DEPARTMENTAL REVIEW.- ;.APPROVED::'-=D ATE' if:.:.DATE TAGS/INOTES/CO1DITIONs:
BUILDING DEPARTMENT
PLANNING DEPARTMENT
PUBLIC �
HEALTH I \14 IN I c r f v a
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