HomeMy WebLinkAboutBLD2025-00481 - BLD Application • Permit No: 2,Lt,2 o2-S - C.C>4gc
., MASON COUNTY RECEIVE®
4 COMMUNITY DEVELOPMENT
\ter Permit Assistance Center,Building,Planning APR 1 8 202C
BUILDING PERMIT APPLICATION J
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION 5 VV.Alder Street
NAME: ASLPIfl. 13U► Gll°�S L.L.C. NAME: • P SLN r\-k- LSU.i lc\t,es LA-C., . •
MAILDNG ADDRESS: pet Lin MAILING ADDRESS:
CITY:York drLl trcl STATE: WP ZIP:�3LAP CITY: mar \e STATE: • ZIP: - '
PHONE#1: "j tep-2;t,r•5—5-0 ic`a PHONE: CELL:
PHONE#2: NA - _ EMAIL: . •
EMAIL:(XSc..e.nj-1ai.J i 0e f5 i1 G Perez; ,�M L&I REG# EXP:_/ /� . - :
PRIMARY CONTACT: • OWNER❑ CONTRACTOR'S OTHER 0
NAME T04,M, Sty revs -N - EMAIL fCt `j'
MAILING ADDRESS 120 1- 1-0----7 CITY'bc— ¢ ,4 STATE OA. ZIP - t• %•
PHONE N1‘ CELL -2 a5- 52 Q .
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 'LZZ t Z - 50- O' .Uo 9 ZONING
LEGAL DESCRIPTION(Ahhrcviatcd) FIRE DISTRICT
SITE ADDRESS /f C 1 C t C L(6,10 c Peek P1Gc.e, CITY Ge—t-cc,.I'-
DIRECTIONS TO SITE ADDRESS �p
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO J� SNOW LOAD:___psf
IN
IS PROPERTY WITHIN 200 FT OF THE FOLLOWG: (Checkanthat apply): i
SALTWATER 0 LAKE❑ RIVER/CREEK 0 POND 0 WETLAND 0 SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW pf ADDITION❑ ALTERATION 0 REPAIR 0 OTHER (7
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.) 5(r
IS USE: PRIMARY ti SEASONAL 0 NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS 2< 5
HEATED STRUCTURE? YES(Whole Bidg) YES(Parris]of Bldg)0 NO❑
DESCRIBE WORK JJJ���
SOUARE FOOTAGE:@vpcved)
1ST FLOOR C q 5 sq.ft. 2ND FLOOR-V 14(0_ sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK CI Lr sq.ft. COVERED DECK C.I sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE 14 On sq.ft. Attached Detached 0 CARPORT sq.ft. Attached 0 Detached 0
MANUFACTURED HOME INFORMATION: NP` *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH--- -----
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC SEWER 0 / NEW IA. EXISTING 0
PLUMBING IN STRUCTURE? YES NO 0 If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS ROPOSED? YES 0 NOO EXISTING SQ.Fr.
EXISTING BEDROOMS PROPOSED BEDROOMS 3 C./TOTAL BEDROOMS .--
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 at the necxssary 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 perm lapplicalion 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 APPLICA 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
Xr Zj
nature of OWN (Must be skirted by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL �
PUBLIC HEALTH / C .V,. el--- SOX CP--d fi�1/Lf CC iJ -C4
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