HomeMy WebLinkAboutBLD2025-00417 - BLD CD Environmental Health Review - 3/17/2025 40Permit No: 9 DDa-�!7
MASON COUNTY RECEIVED
COMMUNITY DEVELOPMENT
Permit Assistance Center,Building,Planning APR 0 3 2025
BUILDING PERMIT APPLICATION 615 W. Alder Skeet
PROPERTY/ OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:A 4 ArbdiCA7k,IV NAME: /71/Pi ns ot,OZ.. D
MAILING ADDRESS: li(/O A/r/5j0.4 6. -&4 MAILING ADDRESS:__._._._.. m
—13
CITY: _STATE: '4- ZIP: 9' 2, CITY: STATE: ZIP: _ nn rn
PHONE#1: !00 y01 54(6 PHONE: CELL: _. --' UIIU z
PHONE#2: EMAIL: C o C
EMAIL: /4.D7ft 3KvJ 76 3 jfr�( Z L&( REG# EXP. /—' m oN
PRIMARY CONTACT: OWNER a CONTRACTOR 0 OTHER 0 vN+
NAMEYL !M 11�,n✓ EMAIL 0
MAILING ADDRESS WO La- Air scrim c..(LCv C CITY �cr/ P/' STATE tv,A — ZIP`r* SR z
PHONE CELL 3G.o Hoi Jfvf i ---I K
PARCEL INFORMATION: `� _ (n
C r PARCEL NUMBER(12 Digit Number) 3a,2 Li^ 5�-, O G,8 ZONING Z
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT
SITE ADDRESS P1 b l Jti r rl ercic CITY i
DIRECTIONS 9 SITE.ADDRESS lu rim.
C.�',iA1 C . t _ two T N '
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 rho(apply):
SALTWATER 0 LAKE 0 RIVER/CREEK 0 POND 0 WETLAND 0 SEASONAL RUNOFF❑ STREAM 0
TYPE OF WORK: NEW 11, ADDITION 0 ALTERATION 0 REPAIR 0 OTHER 0 ,
USE OF STRUCTURE(Rrndeace.Garage.Craawerrwl 8/4 Ere.)
IS USE: PRIMARY 1 SEASONAL 0 NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS 2
HEATED STRUCTURE? YES(WhoteBldg). YES(Pon(r/ofBldg)0 NO 0
DESCRIBE.WORK
SOUARE FOOTAGE:rpeopored)
1ST FLOOR 131 6 sq.lt. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.It.
I DECK /Yq sq.ft. COVERED DECK ao sq.ft. STORAGE sq.ft. OTIIER sq.ft.
GARAGE sq.ft. Attached❑ Detached 0 CARPORT sq.ft. Attached 0 Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR __ LENGTH .__
•
WIDTH _ BEDROOMS BATHS _.._SERIAL NUMBER________
ENVIRONMENTAL HEALTH: •
SEWAGE/SEWER SOURCE: SEPTIC SEWER 0 / NEW a EXISTING 0
•
PLUMBING IN STRUCTURE? YES 0 NO❑ If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES ll NOD EXISTING SQ.FT.
EXISTING BEDROOMS (?_____ PROPOSED BEDROOMS 3 v TOTAL BEDROOMS 3.._.....
OWNER acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such*by
signature below.I declare that 1 sin the owner and I further declare that 1 am entitled to receive this permit and to do the work as proposed.I have
obtained permission from a1 the necessary parties.including any easement holder or parties of interest regarding that 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/applicatbn becomes null&void it work or authorized construction is not commenced within 180
days or 8 construction work*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
�/ ll,,__ COUNTY CODE 14.08.42)
X j 1, r5oA) /nape t /7 04oa5
Signature of OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH 0 - 4(30(1; catI" `R116(
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5 MASON COUNTY ENVIRONMENTAL HEALTH
0 500 Gallon Pre-Trash tank RET
00NuWater BNR-500 ATU Tank
O 1,000 Gallon Pump Chamber
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