HomeMy WebLinkAboutBLD2025-00374 - BLD CD Environmental Health Review - 4/28/2025 Permit No: BL�2O2%-UO379
MASON COUNTY
COMMUNITY DEVELOPMENT RECEIVED
Permit Assistance Center,Building,Planning
BUILDING PERMIT APPLICATION MAR 2 6 2025
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION
NAME: �Ar NAME: k \L—. r'1L � S 615 W.Alder Street
MAR IN�ADDI�ESS:bq In 1t t C I MAILING ADDRESS: Y•0,Lxa• 1 Ct�1
CITY: STATE:1/R ZIP:� '° -1 CITY: e t Q, STATE:W P� �':-' I
PHONE#1:3 1l-3 )S PHONE:-999..- riT5I�
PHONE#2: EMAIL: w,n-- t' In hk 11 t 1 S'.0 Jit�
EMAIL:Ot,(1� 't, I O IY�G.I .C Q rn L&I REG#�L f n V XP. / 3/a b
PRIMARY CONT CT: OWNER. CONTRACTOR D OTHER[
( NAME f'�C EMAIL Qa1E.`iI �3mql •Cen"
MAILING ADD S S ` 1 &t C CITY IN _ i a STATE W p__PS ZIP
PHONE 3(�Q— (\j —�C S�4 CELL 3 100—9bk4—31I SQ
PARCEL INFORMATION: r�
PARCEL NUMBER(12 Digit Number) '5 4R p 1—t -�"1 -vV (4 O ,��Z G L --aS
LEGAL DESCRIPTION(Abbreviated) Tik l0 t)F S'`1i SE PCL LiVi FI Atic�i-°-1 i Li( SITE ADDRESS 7QQ SF LAM C,r'ee S, CITY . ' .Q CI01
DIRECTIONS TO SITE ADDRESS1 kith kl 11 f l( R- 9 GI 7 f�l t i. W Cl
C)r r94,, S ( h4 up c,oSs.\-- ia�2/ t,CC S l Thry ct ( L V UU 1IS THE PROJECT WITHIN 300 FT OF SLOE(S)GREATER THAN 14%: YES❑ NIO N SNOW LOAD:__psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all thotapply):
SALTWATER 0 LAKE 0 RIVER/CREEK 0 POND 0 WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW o ADDITION❑ ALTERATION 0 REPAIR 0 OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.) Rev k 0(.n Ce,
IS USE: PRIMARY 1 SEASONAL 0 NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole Bldg)Ill YES(Pan(s)ofBldg)0 NO❑
DESCRIBE WORKTO bu 11d VW/ Z bed t too* S ITt SToni tr M—e.
SOUARE FOOTAGE:(proposed/ •J
( 1ST FLOOR V S sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft-
GARAGES
�_Li sq.ft. Attached. Detached 0 CARPORT sq.ft. Attached❑ Detached 0
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 II EXISTING 0
PLUMBING IN STRUCTURE? YES II NO 0 If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NO❑ EXISTING SQ.FT.
EXISTING BEDROOMS ej PROPOSED BEDROOMS .2 TOTAL BEDROOMS ,Q
OWNER acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.Admowledgement 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.indudng 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 d Mason County access to the above described property
and stnx ture(s)for review and inspection. This permit/application becomes null&void if work or authorized consbuction is not conanenced 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)
x .CAi(i� 3 1 1 Q �?S
Signature f O NER Must be slaned by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH Ø..f(ii can((Notacleuf
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Parce. ( te
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*NOT AN APPROVED SEPTIC DESIGN*
Use approved septic design for septic system installation r' -.
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D a RR5 STANDARD SETBACKS* V�
r— Front: 25'13 �.
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m Z Sides: 20' �
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5- o -113 *unless otherwise stated on the site plan `
C ( 3 Iv *all setbacks measured from the farthest • .:—
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