HomeMy WebLinkAboutBLD2025-00463 - BLD CD Environmental Health Review - 4/18/2025, 7....-: MASON COUNTY Permit No: !e1 as y E D
COMMUNITY DEVELOPMENT APR 15 2025
` ' Permit Assistance Center, Building,Planning
15 . AI er Street
BUILDING PERMIT APPLICATION D L��ht II L +iUYt_,
PROPERTY OWNERR INFORMATION:
\ CONTRACTOR INFORMATION:
NAME:3\Q Nam? ID`av,. �w_.1eY'LC-1� NAME: Co4rr }'1-ev►� S ew�, `�
MAILING AD JRESS:Ck= _a o�1„k l� MAILING ADDRESS:ad►O ' �}v.e Sl+l) t1
CITY: 5 Q1ry, STATE: , : "ZIP:q2. 4 CITY:T, „1,�,... �!' STATE:'AA) ZIP:�2513, .�
PHONE#1: rts 30d1• .'Lk PHONE:& 5?�9•1141 CELL: 1W�oQr \iO• 1
PHONE#2: I► Sa C'i(e a EMAIL: akrreit? _cd1 C�.9�t'�e*�e`'t,• r
EMAIL: 5A 0.r �t"tt �Q0\ •C�h L&I RE 61- Al C.—'7(�Ql� EXP. t 4541/ .'� c2-t C� %
ft‘ CO
PRIMARY CONTACT: t \ OWNER❑ CONTRACTOR Qp��THER❑ L r=
NAME Cgarre.W rre...a EMAIL a rr-enlate Ctrr,S�trv.cl'.v.,..N� Q
MAILING ADDRESS a.°1OO Awe 6W -0" �- CaTY to..'4Q STATE WA ZIPI51. 3S .7-
PHONE (:3(po) 53CI-"lt i CELL L31m) 4:110• —133v
PARCEL INFORMATION: II
PARCEL NUMBER(12 Digit Number) 3 I q d C• s/" 00 C/� ZONING/S r�r)t l4 R
LEGAL DESCRIPTION(Abbreviated)So trc Lnkc. 17,4--r el. A S t/C ext5.AFIRE DISTRICT
SITE ADDRESS 9ZO W 1)41-(i 11,4 p,ck QJ CITY $A�fhp4
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO k] SNOW LOAD:_psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
, SALTWATER❑ LAKE K RIVER/CREEK 0 POND 0 WETLAND❑ SEASONAL RUNOFF 0 STREAM❑
TYPE OF WORK: NEW❑ ADDITION❑ ALTERATION❑ REPAIR❑ OTHER Q' Rew,d.
USE OF STRUCTURE(Residence.Garage.Commercial Bldg,Etc.) 74;es%dt,...C..'Q
IS USE: PRIMARY E SEASONAL❑ NUMBER OF BEDROOMS j NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(W7role Bldg)W YES(Pants)of Bldg)0 NO 0
DESCRIBE WORK .--. 20,4oc1e1 0.twck 0,�11 w 9a.ro•Ae
SQUARE FOOTAGE:(proposed) J
1ST FLOOR ('HJ sq.ft. 2ND FLOOR /414'7 sq.ft. 3RD FLOOR_ sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER _ sq.ft.
GARAGE SO<{ sq.ft. Attached❑ Detached❑ CARPORT sq.ft. Attached 0 Detached❑
MANUFACTU NATION: N/Pc *4 COPIES OF THE FLOOR PLAN REQUI D*
MAKE MODEL YEAR LE _
WI H BEDROOMS BATHS ER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC Ff SEWER 0 / NEW❑ EXISTING
PLUMBING IN STRUCTURE? YES RI NO 0 If yes.attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES, NOD EXISTING SQ.FT. Z.'1(-(
�[
EXISTING BEDROOMS ( PROPOSED BEDROOMS 3 TOTAL BEDROOMS 3
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 structures)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)
X 51 //0.5-
Signature of OWNER(Must be signed by the OWNER) ate
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH Sit/Lc' UP( LS CQd4-
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b.A• Gi\e a 1--...sr .. ,1 Mason county Dept.Health Services
E EH Setbacks AppROVEa
A.)DrainhelMieserve requires 10 setback from looting/foundations
�Q- � �e\\0. B.)Septic tanks)requires 5�selbadc from as fodown oundatiof (ntfte
\1`e C.)No foundahon/Renmeter Drains wihin 30ft,dow_gradient of �10 1�
Draintield! area —
D.)No Cut ank(s)(greater than 5ft and over 45 degrees) in
L 50ff.down pradiant of Draineetd'Reserve area
_-_ f. Use rowedmitigation fromseebon Ct-.ofnte dap ant of
e s'�riteria For Sewage Works Desgn"when sewer
•�~ transport;es are within 108 of water supply tines.
1 e.• EH APPROVED •
..f-,Slrn, 1 ` 1r K 4I Rhonda Thompson 05,0842025
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