HomeMy WebLinkAboutBLD225-00243 - BLD CD Environmental Health Review - 4/6/2025 'MgrPermit Assistance Center, Building,Planning
BUILDING PERMIT APPLICATION /1 l -1�I c' r)- �L - 71/
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:(�'(1 01-,\`Cr NAME:
MAILING A DRESS: "PC) K a`7 7 MAILING ADDRESS:
CITY: }- STATE:w1r ZIP: 4g5Li CITY: STATE: ZIP:
PHONE#1: Zoo —y 76) _79 31 PHONE: CELL:
PHONE#2: EMAIL:
EMAIL: cLy,,A,A l 95 e. 4(YY.2.i I ,-C Ot'l L&I REG# E './ �
PRIMARY CONTAC ITj OWNER' CONTRACTOR❑ OTHER❑ �0 f
NAME Z` ifYLC., EMAIL <IN `P
MAILING ADDRESS CITY STATE ZIP T
PHONE CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) y a0 1(5 t�% '(0 ZONING
7
LEGAL DESCRIPTION3 (Abbreviated) FIRE DISTRICT l Cam'
SITE ADDRESS "1 1 k) V--\ nej C.ce Sc CITY 1-17X,dp SD(4-
DIRECTIONS TO SITE ADDRESS 1
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESO NO 0 SNOW LOAD: psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER 0 LAKE 0 RIVER/CREEK 0 POND 0 WETLAND 0 SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW 0 ADDITION ❑ ALTERATIONN REPAIR 0 OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.) RS iGj.'e,.'tCe.
IS USE: PRIMARY 12C, SEASONAL 0 NUMBER OF BEDROOMS a NUMBER OF BATHROOMS a
HEATED STRUCTURE? YES(Whole Bldg)0 YES(Bart(s]of Bldg); jif6'❑ 1.LDO
DESCRIBE WORK FCC I`-71 I r o)1` hji,l.1 t, vrmet ILL! Li ll e' g0E1-, -Li)
SQUARE FOOTAGE: (prnpo�dd) �14 t C1 6V ACI - Rin ]f' L4 .,L,t'"`
eie
1ST FLOOR Rbq sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. 13A EMENT �t sq(ft.
DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft-
GARAGE •• _sq.ft. Attached Detached❑ CARPORT sq.ft. Attached 0 Detached❑
MANUF HOME INFORMATIO : * OPIES OF THE FLOOR PLAN REQUIRE *
MODEL, YEAR
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC X SEWER 0 / NEW 0 EXISTING 0
PLUMBING IN STRUCTURE? YES pt NO 0 If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NOX 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 arriirate 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 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 OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
--->/( -5/-27 1
2,5
Signature of OWNER(Must be signed by the OWNER) ate
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
(4 0 R- kl1611S _ca�a' .� aa�iee!
PLANNING DEPARTMENT
EH SETBACKS
A)Grainfield/Reserve requires 10'setback from footing/foundations
B)Septic tank(s)requires 5'setback from all footing/foundations
C)No foundation/perimeter drains within 30'clown-gradient of drainfield/
reserve area
Si APPROVED D)No cut(s),bank(s)(greater than 5'&over 45 degrees)within 50'
down-gradient of drainfield/reserve area
_-� MASON COUNTY D C D PLANNING E)Sewer by transport lia may only be within a li of aes watsr supply line if
approved by the local health officer and the line is constructed IAW section
C1-9 of the DoE"Criteria For Sewage Works Design".
SITE PLAN REQUIRED TO BE ON SITE
CHANGES SUBJECT TO APPROVAL ll;LA-.h4., fr,i c vne.ok
,�/ EH APPROVED
By: /' Date: 04/03/2025at
r� - Anderson04/16/2025
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Disclaimer:
i-1e. ✓1 rrr Mason County does not require a
i survey to obtain a building permit.
i As a result, site plans may not
1 reflect accurate data. It is the
PLANNING SETBACKS \\\\ +f• -NI - I t applicant's responsibility to comply
Setbacks measured from -� ,1, I, /.i with setback requirements.
tll
farthest projection of structur,J r - -
Nt�r
Front: 25' / .A, 4- 12A T•
Rear: 20' ',war . t4r°tr, '
Side: 7' C' pry/ _ _ Cum
*Subject to EH Setbacks .i `''�
ticr ('J�.e........
TOPOGRAPHY PROFILE- J
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2 Direction. Ijov-k1n 1 Scale: Approval: foro c use
Building Permit number:�i i 1.01.23-Or) (2--2--1 4�r„i m )0 Building:,
Owner/Applicant !' cr _..y' ��`�k�Y Date OT Planting:
ap Env. Health:
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LAKE CUSHMAWSEPTICS
N.•31 Canvasback Pi,
Hoodsport,WA 98548
(206) 877.5345
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