HomeMy WebLinkAboutBLD2025-00334 - BLD CD Environmental Health Review - 1/13/2025 MASON COUNTY Permit No: 16L0202S- 00334
t . .) COMMUNITY DEVELOPMENT
\', ' Permit Assistance Center, Building,Planning RECEIVED
BUILDING PERMIT APPLICATION MAR 1 8 202
PROPERTY OWNER INFORMATION: l CONTRACTOR INFORMATION:
NAME: /01,01 A t.C.�Ne /'YO tJ)1 NAME: i)E TPZA S L�.W Aide -2r : ..
MAILING ADDRESS: /60 ,(/ /JUC,eAnUSN 4P WMAILING ADDRESS: ( , / G/ .G
CITY:rcW ,os'T STATE: !tic?- ZIP: 9 g"..M y CITY:D/ilicovil A- STATE:it:M.._ ZIP: ?5 t:3
PHONE#1: 96.-f/5--6/9 2- PHONE 6 Vr/•9$?OCELL:%0 2 '9 72.0S,
PHONE#2: EMAIL:G4/2y. Per/2.A7 �( iAi/. - •1
EMAIL: L&I REG#fJ�r le 97 f3r EXP.3 I3O I2-s -
PRIMARY CONTACT: OWNER 0 CONTRACTOR Er- OTHER 0 ''
NAME 64 ,
bit-2-447 EMAIL `�e
MAILING ADDRESS CITY STATE ZIP TO 0-
PHONE CELL O
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) Z 4) 5-000/f ZONING 9415
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT
SITE ADDRESS /60 y. .0 ve.<a. ii s G /, Gins: CITY /sue^?-
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESEr NO 0 SNOW LOAD:,a_psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER 0 LAKE 0 RIVER/CREEK 0 POND 0 WETLAND 0 SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW Q' ADDITION❑ ALTERATION❑ REPAIR 0 OTHER 0
USE OF STRUCTURE(Residence.Garage,Commercial Bldg,Etc.) 2£l-
I IS USE: PRIMARY[SEASONAL 0 NUMBER OF BEDROOMS 7- NUMBER OF BATHROOMS 7-
HEATED STRUCTURE? YES(Whole Bldg)Er YES(Part[sf of Bldg)0 NO 0
DESCRIBE WORK ,1A6 .- /S£ T /KGb 114 e
SOUARE FOOTAGE:(proposed)
1ST FLOOR 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.
GARAGE sq.ft. Attached❑ Detached 0 CARPORT sq.ft. Attached 0 Detached 0
MANUFACTURED HOME INFORMATION:: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE Siey///lam G MODEL d/ D YEAR '5 LENGTH 6 47/
WIDTH Z 7 BEDROOMS 2- BATHS 2- SERIAL NUMBER / e 0
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC II SEWER 0 / NEW 0 EXISTING iir-
PLUMBING IN STRUCTURE? YES DV- NO❑ If yes,attach completed Water Adequacy Form
PERMETER'FOUNDATION DRAINS PROPOSED? YES 0 NOV EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS -2.----
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 APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
62---
/—/3 -Z,
Sig ure of OWNER be signed by the OWNER) Date
DEPARTMENTAL REVIE APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL } �� 'n y,j
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