HomeMy WebLinkAboutBLD2025-00335 - BLD CD Environmental Health Review - 3/20/2025 ,
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.` MASON COUNTY Permit No: BLD2O2S�vo335
COMMUNITY DEVELOPMENT RECEIVED
_% Permit Assistance Center, Building,Planning MAR Z t 2025
BUILDING PERMIT APPLICATION
PROPERTY OWNE,INFORMATION: CONTRACTOR INFORMATION: 615 W.Alder Street
NAME:1 p�•I t a. go h NAME: I s 1- lea- A,
MAILIN ADDRESS: s r11.I. R a MAILIN r ADDRESS:
J Dr
CITY: i �G�• 7 ZIP.#g i CITY: STATE: ZIP:_ 14 1
PHONE 01: _• We �i I 'a- PHONE: CELL: - . i,
PHONE# • ,• ialro'ii - EMAIL:
EMAIL:G I go.. 77* ' ALTii".1'I • _ Ldr.I REG# EXP. II 'o
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PRIMA CQN • CT: OWNER of CONTRACTOR 0 OTHER 0 ) uU
NAME �d�a��1Y�� ..• EMAIL L
MAILING ADDRESS 1,lL,7S:�U= CITY STATE ZIP s-
PHONE CELL �I�" S
PARCEL INFORMATION: q
PARCEL NUMBER(12 Digit Number) H a dA 0 1 50000 Up ZONING
LEGAL DESC ON(Abbreviated) 1 L 0 FA ISTRIto
SITE ADDRESS CITY 0 otpc, - I
DIRECTIONS TO SITE ADDRESS
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: (O.erk.l that applyl:
SALTWATER 0 LAKE 0 RIVER/CREEK 0 POND 0 WETLAND❑ SEASONAL RUNOFF 0 STREAM❑
TYPE OF WORK: NEW$ ADDITION❑ ALTEP;ATION 0 REPAIR❑ OTHER [1
USE OF STRUCTURE(Residence.Garage,Commercial Bldg.The)_r g is (f 1 (�JC_11 _
IS USE: PRIMARY 10 SEASONAL 0 NUMBER OF BEDROOMS V _ NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(who'.Bay 0 YES(Pert(:/ojaldg)❑ NO git
DESCRIBE WORK
OUARE FOOTAGE: (ropas d)
1ST FLOOR sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT _sq.ft.
DECK sq.ft COVERED DECK _..,_sq.fl. STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft. Attached 0 Detached❑ CARPORT sq.ft Attached 0 Detached❑
MANUFACTURED HOME INFORMATION: e4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE_ MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC Pjl SEWER❑ / NEW❑ EXISTING of
PLUMBING IN STRUCTURE? YES 0 NO pit
If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NO1, EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS // / TOTAL BEDROOMS
OWNER actiomsetlpes that submission of inaccurate information may result in a sto6Y_woorrk order or permit revocation Acknowledgement of such s by
signature below I declare that I am the owner and I further declare that I am entitled to receive the permit and to do the work as proposed I have
obtained permission from all the necessary parties.includng any easement holder or parties of interest regarding the protect. The owner or legal
representative.represents that the information provided a accurate and grants employees of Mason County access to the stove described property
and structure(s)for review and inspection The permt/application becomes null 8 void if work or authorized Oonatruction is not commenced within 180
days or t 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 �(A/ e--�_/ _ L 'a o
Cure of WNER(Must be sinned by the OWNER) Dat
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL -� 4��� 0 / 0
PUBLIC HEALTH _ r`•'s"� �(�,„L•J�
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