HomeMy WebLinkAboutBLD2025-00271 - BLD CD Environmental Health Review - 1/15/2025 /,_.. Permit No: BL_O2O2S - OO 11
«� MASON COUNTY
'' /; COMMUNITY DEVELOPMENT
Permit Assistance Center,Building,Planning -
-.. EC�
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATIONMAR 1 Q Li.`
NAME:14 C�t,V1 01 SOeV NAME: ok-M 1� 0.S itgW t �<IN ' ..--
MAILING ADDRESS:I,Z0 Y5 c ck Q Y11Z. IA MAILING ADDRESS: .1, `
CITY: 0 A 1 mil STATE: 4.) ZIP:�' 2. CITY: STATE: ZIP: Gt�`
PHONE#1: Z_Sq •- .LC— Ell Z PHONE: CELL: Q '
PHONE#2: EMAIL:
EMAIL: hcl 0("'D�jp-1C Ct Q?.1O I REG# EXP. / /—
PRIMARY CONTACT:'``*// OWNS CONTRACTOR❑ OTHER 0
NAME K��tn 1 en el EMAIL
MAILING ADDRESS CITY STATE ZIP
PHONE CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) -3 2._I 2_7 "SO Qpo1 T'a ZONING
LEGAL DESCRIPTION(Abbreviated)IA ,..Y1y Q L.(sir e.rtc k Q v O{1r3 1RE DISTRI Ce4-rr1 mason
SITE ADDRESS k GO E. s Sa,i l e yx-k' r k.S� - CITY b.i 4-o✓1
DIRECTIONS TO SITE ADDRESS .244 D ev1 v1 Le_ my\ r 15 +
_2-,l(11c Q�It1�Ji."4tAL� +e> a1...r r Li' 1 C>vt f!' ,4- s t.e,..
IS THE PROJECT WITHIN 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❑ LAKE 0 RIVER/CREEK 0 POND 0 WETLAND 0 SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEI ADDITION 0 ALTERATION❑ REPAIR 0 OTHER 1
USE OF STRUCTURE(Residence.Garage,Commercial Bldg,Eta) e;�.sn .ya / r e S t/1P�1 am,'e ,
IS USE: PRIMARY❑ SEASONAL , NUMBER OF BEDROOMS 1 NUMBER OF BATHROOMS_ i,.
HEATED STRUCTURE? YES(whole Bldg)0 YES(Pants)of Bldg) NO 0 _
DESCRIBE WORK B t J ('�y�SDI-trI 1L-F t O — C�c�v:aca. F� Li yin g E^Z.
SQUARE FOOTAGE:(@posed)
1ST FLOOR sq.ft. 2ND FLOOR33& sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE b sq.ft. Attached,'Detached CARPORT sq.ft. Attached 0 Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL LENGTH
DTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC SEWER❑ / NEW 0 EXISTING❑
PLUMBING IN STRUCTURE? YES NO 0 If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YEE NO 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 accurate 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 AP LICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
X //i S z°25—
Sig ture of OWNER(Must be signed by the OWNER) Dat
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL. �� fA �f
PUBLIC HEALTH fJ / I /1rA ",, U
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