HomeMy WebLinkAboutBLD2025-00508 - BLD CD Environmental Health Review - 4/24/2025 MASON COUNTY Permit Noi ( ALT;1 -C41EC EIVEE
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COMMUNITY DEVELOPMENT
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APR 2Permit Assistance Center, Building,Planning 4 2025
BUILDING PERMIT APPLICATION 615 er Stree.
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: /�
NAMEDA\'� J 0 5('D I I( NAME: A %
MAILING ADD SS: $1 E. ( LW 454--_ ,/ MAILING ADDRESS: Z/CITY: S�LTO /STATE: WA. ZIP: 5 4� CITY: STATE: ZIP: ?�
PHONE#1: 3 tee —t{&QQ,� c O�Z PHONE: CELL: "N/i) r,11
PHONE#2:_36,U-el tobi9 -Z7S EMAIL: ` O<
EMAIL: pAlisp EL-ioA/ L) g et1.4. L AI G# EXP. I / FO
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PRIMARY CONTACT: Ai qWNERig CONTRACTOR❑ OTHER 0
NAME j A✓( 1 ` C-6 i I1 EMAIL LR „/
PHONE MAILING AA_) E S C CITY STATE ZIP �`
PARCEL INFORMATION:
- CELL
PARCEL NUMBER(12 Digit Number) 3zo7._1 - s Q-a 7 0 Z 4 ZONING
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT
SITE ADDRESS S`L.O L. 1.....)000 Q Lig CITY S f 1 c L "J
DIRECTIONS TO SITE ADDRESS S/4orec rr°s T
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO le SNOW LOAD:3O psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER 0 LAKE 0 RIVER/CREEK 0 POND 0 WETLAND 0 SEASONAL RUNOFF 0 STREAM❑
TYPE OF WORK: NEW; ADDITION 0 ALTERATION t❑ REPAIR 0 OTHER ❑ ( , I ^, /
USE OF STRUCTURE(Residence.Garage.Commercial Bldg.Etc.) 1 .ff.�Y ) I (nt`CC .AO i V�I I I�`•, L (1�'"W I!�r L,1 &U l LZ
° IS USE: PRIMARY❑ SEASONAL 0 NUMBER OF BEDROOMS NUMBER OF BATHROOMS
ZHEATED STRUCTURE? YES(Whole Bldg)0 YES(Parr[r]of 81dg)0 NO 0
DESCRIBE WORK
4 SQUARE FOOTAGE:�1�y (proposed)
,i 1ST FLOOR!OU.O sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft. Attached 0 Detached 0 CARPORT sq.ft. Attached❑ Detached❑
MANUFACTURED HOME
JIINFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE I Cu �U .�h f J�MODEL&v✓ALf prt'f$(4/L YEAR z0'L,S LENGTH ,,'/
h WIDTH Z a— ., BEDROOM MS Z. BATHS Z SERIAL NUMBER /33 c/3
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC SEWER 0 / NEW❑ EXISTING
PLUMBING IN STRUCTURE? YES NO 0 If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NOW EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 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 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 8 void if work or authorized construction is not commenced within 180
days or if construction work a 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 1 0 YS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42) � I 'i
X Si na jre of OWNER(Must e signed by the OWNER) �Z Date
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DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
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