HomeMy WebLinkAboutBLD2025-00367 - BLD CD Environmental Health Review - 5/9/2025 iiim
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MASON COUNTY Permit No:
RIZLE.iVED
COMMUNITY DEVELOPMENT MAR 2 5 2025
Permit Assistance Center, Building,Planning
BUILDING PERMIT APPUCATION 615 W. Alder Skeet
PROPERTY OWNER INFORMATION: I CONTRACTOR INFORMATION:M
NAME: Dr GY`n NAME:PinnarlQC.O�1m -�' �rl
MAILI"s nnR F. : l9j_N1 f1 T MAILING ADDRESS:A ID W� 3 ST* rn
CITY( fit ( s 1 A 1 t:>,�j r-, 7.u$Y.4 CITY' STAT ,JA 7JP.Arty'
PHONE :)too -C91-8323 PHON (pb -31 1OCELL• - z
PHONE M2: EMAIL: ivitylibliAncitalp,t0 • p'Y` C
EMAIL:AtatanatifD n l lie a ItillOU.L/M L I REG I swept CASH. I2 EXPAstA1 • _ .0
__^PRIMARY(YQNTACT: ON NER❑ CONTRACTOR . OTHER 0 O
• NAME 'WICK 'OVsv J WI EMAI1, ' • a," . b•.$ ' •.a . ' 1 Z
MIAKDITIESS fl kWA - t $1rrof S ytAc ( Cf(Y . . STATE • zIPiv.< K
PARCEL INFORMATION:
r} 1 S
PARCEL NUMBF3t(12 Digit Number)1 1 -5 1- Q Ot 35 7,ONIVGCj
LEGAL DESCRIPTION(Abbrcviated)g ) (O4e Dat) g Lu4' 133 !IRE DISTRICT N•massy, co,_'
SITE ADDRESS b w r 1_ IA CRY ' C t f I—
l QNS T RITE ADDRESS 01 j•��� is" 13 v I, -•- k� o• L �[1/
f d , & oc O� ltkrir " ' # '1 0n rQa� •
IS THE PROJECT WITHIN 300 FT OF SLOPES)GREATER THAN 14%: YES[) NON SNOW LOAD3t) t.st $
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: 'eked a4'that apply):
SALTWATER 0 LAKE 0 RIVELUCREEK 0 POND 0 WF.Tt.ANO0 SEASONAL RUNOFF 0 STREAM 0 i
TYPE OF WORK: NEWk ADDITION 0 ALTERATIONN 0 REPAIR 0 OTHER 0
USE OF STRUCTURE(Reside+.t, m. .Cosat .Elf.'etilkI\(e,
IS USE: PRIMARY SEASONAL 0 NUMBER OF BEDROOMS Z NUMBER OF BATHROOMS t
HEATED STRUCTURE? YES amok mai YES/P sl of Dirt)0 NO 0
DESCRIBE WORKSAs4ll t 11) 'hnLj If10M.c.(OAn((* 40 i'l�
SQUARE FOOTAGE:t .ar.d,
1ST FLOOR34 I sq.ft. 2ND 11.0010(f t sq.ft. 3RD FIAORN l sq.ft_ RASEME-NT U f sq.R.
d y
DECK t 10 sq.IL COVERED DECK e a sq.fl. STORAGE N A• sq.IL OTHER/U IA sq.It.
GARAGE N 1 A sq.ft. Attached 0 Detached 0 CARPORT I sq.R. Aftaeked❑ Detached 0
MANUFACTURED ROME INFORMATION:Y►A *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKECr1(j.rn Ion MODEI.PME74 7
I YEAR O2-5 LENGTH 341 II"
WIDTH 1 11 2.11 BEDROOMS ca, BATHS I SERIAL NUMBER Tab
ENVIRONMENTAL HEALTH:
SEWAGESEWFRR SOURCE: SEPTIC:' SEWER 0 NEW 0 EXISTING]
PLUMBING IN STRUCTURE? YESNI NO 0 /firs.attach completed Ilater,aJeyrwcy Form
PERLMETEWF7)UNDATION DRAINS PROPOSED? A-Ls 0 Nt� EXISTING SQ.FT.
IiXISfING BEDROOMS (1) PROPOSED BEDROOMS a ' TOTAL BEDROOMS
OWNER adisiya11dpls Mal submission of itiouraM inknnwion my result in e atop work order or permit,esvcW .Ad maisdpasnwK Mauch is by
siorrouto beim Idodss•Om Imo she ewer Ind I Arthur dedre tut I an angled to maim this panne and to dada
cbtsinsd vswtlsdonproWIde argessfra *hang e ivy +bo se pra of Wrest reposing T «M m .psl
npwsusMrk sspssawKs set Ike Irhatisilort prVWdsd Is ammo and gams amplorees of Mason Caeasy access Odra shoes dasatbad MPwh
end iMmbnI(s►1or wee*and inspection•This perrniVappiation becomes raa a void if work or auMdired construction is sot consnrred satin 11r0
days or Acons melon work is suspended kr a pedod of 180 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPUCATK)N OF 180 DAYS OF MORE WILL CAUSE THE APPUCATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
Area Ahderroh 03/15/25
Signature of OWNER(Must be cloned by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGSINOTESACONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL �Q e,,
PUBLIC HEALTH Pig 5/7/1: (Old/ f",$4., 'QJ�
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