HomeMy WebLinkAboutBLD2025-00435 - BLD CD Environmental Health Review - 5/9/2025 MASON COUNTY Permit Noren(.l 24,.).v,5-C Y •/2
COMMUNITY DEVELOPMENT
RECEIVED
Permit Assistance Center, Building,Planning APR 09 2025
BUILDING PERMIT APPLICATION 615 W. Alder Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME � 'J
/ + aI ec NAME:
MAILING A DRESS: I elaG�/ SG } 7 MAILING ADDRESS:
CITY:,(,!,., STATE:I ZIP:7 Coy, CITY: STATE: ZIP:
PHONE#1: V9.04. -5/() 1 y,?f PHONE: CELL:
PHONE#2: 2-pb -c/47-g,5-eS EMAIL:
EMAIL:CA.44e"(d cte!p h.ed ce /docr.'.tour! L&I REG# EXP. /_/_
PRIMARY CONTACT: OWNER ' CONTRACTOR❑ / OTHER
NAME r'AGt ri/r cc1 c�J�•'1 S EMAIL L�Z�L -1'�Q Y'cp4 1f® 1 c L(id.G>F'7 D
MAILING ADDRESS / pelf S f a.0.)-4(16-1 CITY..+, STA E Lvl' ZIP �.C)Q 1. m
PHONE )p( Ir9 I y3/ CELL �G>f; -�/0 'N3(n C7 El
m
PARCEL INFORMATIO\: C c
PARCEL NUMBER(12 Digit Number) ;�tL Cif d rj ^ 5/ "Q`(xx)8 ZONING ato
IV
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT
f-r;
SITE ADDRESS 2ai V• tett bc/e7 t A . .. CITY 1"„1/ r, ti
DIRECTIONS TO SITE ADDRESS
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❑ RIVER/CREEK 0 POND 0 WETLAND 0 SEASONAL RUNOFF 0 STREAM❑
TYPE OF WORK: NEVI ADDITION❑ ALTERATION 0 REPAIR 0 OTHER 11
USE OF STRUCTURE(Reridence,Garage,Commercial Bldg Ere.)
I USE: PRIMARY 0 SEASONALX NUMBER OF BEDROOMS 47., NUMBER OF BATHROOMS
A D STRUCTURE? YES(thole Bldg/ YES(Parris)ofBtdgr NO 0
' ` ES BE WORK Fi try non-e,i . P f(Q Gl l w /L'c
DARE FOOTAGE: i . I SO(P• k 2. 1 l —6 A6E +J-f
1 1ST R /17y sq. t�FLOOR ��j sq.ft. 3RD FLOOR sq.ft. BASE T sq.ft.
DECK 'Z ft. COVERED DECK q.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE'7q sq.ft. AttachedE Detached 0 3ZE CARPORT sq.ft. Attached 0 Detached 0
MAl IJFAC_TURED HOM ' PIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WID BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC lit SEWER 0 / NEW'S EXISTING❑
PLUMBING IN STRUCTURE? YES fi' NO 0 If yes,attach completed Water Adequa , un- -
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NOD STING SQ.FT.
EXISTING BEDROOMS _�ef ^
PROPOSED BEDROOMS TOTAL BEDROOMS a
OWNER acknowledges that submission of Inaccurate Information may result in a stop 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 t calve this permit and to do the work as proposed.I have
obtained permission from all the necessary parties,inducing any easement holder parties of Interest regardin or gal
representative,represents that the information provided is accurate and grants emp ees of M 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
PERM AP' C•eN OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
X dAll 4 COUNTY CODE 14.08.42)
14/Atli file lit .......__.f ---
-tgnature of•WNE- TirTrrrtrrrnnTitei. . :) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
M
FIRE MI' Siij
PUBLICIC HEALTH
HEALTH r
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