HomeMy WebLinkAboutBLD2025-00277 - BLD CD Environmental Health Review - 3/10/2025 , Dm
71
. ,, MASON COUNTY ea
Permit I
.- '' COMMUNITY DEVELOPMENT MAR 1 1 2025
/ Permit Assistance Center,Building,Planning
BUILDING PERMIT APPLICATION 615 W. Aid: Skeet
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PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: e,9 --
NAME: NAME.: CW 1-1. 4,(‹. J
MAILING A RESS: MAILING ADDRESS: •11r- =C O m 1.4
CITY: STATE:1,�Pt,-ZIP: CITY: W11t10.- STATE: . ' ZIP:° Un- G �rf D
PHONE#1:"Ag)•' t�Q PIIONE:•2s3 Ute ELL: FO r K
PHONE#2: � • I • �illllllll -] -- EMAIL"Con.S4rxrA;Onp L}VOIV ISSY425•C
EMAIL: _I ..__._ 1.41 REG# EXP. !_/_ M
PRIMARY CONTACT O ER pit CONTRACTOR 0 OTHER Z
NAME EMAIL _
MAILING DRESS- _ _ _ CITY ' SfA'I St ZIP D
PHONE i V 2 .�IlLJ CELL r
PARCEL INFORMATION:
. PARCEL NUMBER(12 Digit Number) �S-C:12-14.11 k•___0 ZONING 9,�.�
LEGAL DESCRIPTION Abbreviated) I/ L_1V FIWS DISTR C�I,_1W ------
SITE ADDRESS
•�1 •
ITY ►(J r
DIRECTIONS TO S ADDRESS______MA h1 tail NUAY113
ell(� LI
IS THE PROJECT WITHLN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO SNOW LOAD: psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply(
SALTWATER 0 LAKE❑ RIVER/CREEK 0 POND❑ WETLAND 0 SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEWg) ADDITION 0 ALTERATION❑ REPAIR❑ OTHER 0
USE OF STRUCTURE(Residence,Garage.C'aremercaal Bldg fx�.) 5 '�W� v L1`� 1�,' `_L
r
IS USE: PRIMARY I� SEASONAL 0 NUMBER OF BEDROOMS 4 NUNH3ER OF BATHROOMS 2 )2
HEATED STRUCTURE? YES(whale We IA YES(Pan isiofew�gt❑ � N�O❑
DESCRIBE WORK N(A J SFrt v! 04'oioy �'-wt"•d g aHcL'y,
SOUARE FOOTAGE:(pmprravll a`
1ST FLOOR ZP1 sq.ft. 2ND FLOOR sq ft. 3RD FLOOR sq ft BASEMENT sq.ft
DECK sq It COVERED DECK•242 sq.ft. STORAGE sq.It OTHER sq.ft.
GARAGE--1w) sq.ft. Attached a Detached 0 CARPORT sq.ft Attached 0 Detached❑
`11IANUFACTURED HOME INFORMAT • *4_MBEs 1 TI E FLOOR PLAN REQUIRED*
101,CE MODEL YEAR ENGTH
WIDTH BEDROOMS BATHS______ _______SERIAL NUMBER__
ENVIRONMENTAL HEALTH:
SEWAGFISEWER SOURCE: SEPTIC, SEWER 0 / NEW 0 EXISTING tie
PLUMBING IN STRUCTURE? YESg• NO❑ tfyes.attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED'' YES g NOD EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS -4 ___
OWNER acknowledges that submission of inaccurate Information may result in a stop work order or permit revocation.AcknorAedgerneni of such is by
signature bekw.I declare that I aril the owner and I further declare that I am entitled to receive This pmmtl 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 protect.The owner or egal
representative.represents that the information provided is accurate and grants employees of Mason County access to the above described property
and sbucture(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 es 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 0 180.PAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
Spy ^OWN (Must signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL PUBLIC HEALTH L 1 ‘11
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