HomeMy WebLinkAboutBLD2025-00489 - BLD CD Environmental Health Review - 5/21/2025 MASON COUNTY Permit No:131.1) � "—
COMMUNITY DEVELOPMENT
R CEIVcD
APR 2 1 2025
Permit Assistance Center,Building,Planning
BUILDING PERMIT APPLICATION 615 . . er Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: i
NAME: I v4/Or e 1 LO NAME: i
MAILING CrZ Ford rtVe- MAILING ADDRESS: �•4 z
CITY:Cif c_ • STATE: ZIP: qg ji l- CITY: STATE: ZIP:'`. <i�
PHONE#1: EL�p g 3 PHONE: CELL: C_
PHONE#2: EMAIL: j I C 3.
EMAIL:GKT • hu 0- —11-Tom L&1 REG# EXP. / F,0 0
PRIMARY CONTACT:,( OWNER lcCONTRACTOR 0 OTHER❑ D z
NAME I rCwr L IIa EMAIL I "
MAILING4DDDRES r C.- CITY Bt eN rtOA STATE IdA ZIP t4 VI a- j --�{
PHONE -360 6 2 Ol L _ CELL z rn
PARCEL INFORMATION: �G.] (jS(
2
PARCEL NUMBER(12 Digi(Number) 2 1-1- -00 g 0 tt ZONING e,/1 T 1 ,G'I D
LEGAL DESCRIPTION(Abbreviat 1_ FIRE DISTRICT r
SITE ADDRESS 60 j%1 Of" r t ew r CITY T G. 0—
ttcr10 S TO SITE ADDRESS C C- et.. ccxn -L c. 1��0T
LVss o-V-b&h
IS THE PROJECT WITHIN 300 FT OF'SLOPES)GREATER THAN 14%: Yf.SD NO"SNOW LOAD:ilapsf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: ((Set all daapply): N/A
SALTWATER 0 LAKE❑ RIVER/CREEK 0 POND 0 WETLAND 0 SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK; NEW pi ADDITION 0 ALTERATION REPAIR 0 OTHER 0
USE OF STRUCTURE RE(Aerdea.r.Ga'ase.ca.n#rirt etas.rec) Res i t?rl
IS USE: PRIMARY 01 SEASONAL.0 NUMBER OF BEDROOMS 1ti
NUMBER OF BATHROOMS
HEATED STRUCTURE?_ hore YES !rl of At,❑ NO --
DESCRIBE WORK IV 0-c-T6-re-a Pori e J—h5-I
SQUARE FOOTAGE:(pr,,powd)
1ST FLOOR I+CO sq.fl. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft. '
DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft OTHER sq.fl.
GARAGE sq.ft. Attached❑ Detached❑ CARPORT sq.ft. Attached 0 Detached 0
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE cc L�
f e- MODEL 9 \TARZC2;C LENGTH 66
WIDTH 2$ BEDROOMS {... BATHS ^..?"- SERIAL NUMBER
ENVIRONMENTAL HEALTH: , /
SEWAGE/SEWER SOURCE: SEPTIC SEWER 0 NEv l EXISTING❑
..
PLUMBING IN STRUCTURE? YES' NO❑ II yes.attach completed Water Adequacy Form
PERIMETER'FOUNDATION DRAINS PROPOSED? YES 0 N EXISTING SQ.FT.
EXISTING BEDROOMS_ PROPOSED BEDROOMS 4 ✓ TOTAL BEDROOMS
OWNER acknowledges that submission of Ina:arate Information may re.uk in a atop work order or penne revocation.Acknnweedgemant of loch Is by
signature below.I declare that I ern the owner and I further declare that I am entitled to receive this permit and to do she work as proposed.I have
obtained permssion from as the necessary parties.including any easement holder or parses of interact regarding this prr$ect 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 structureis)for review and Inspection. This penNtlapplicat;cn becomes null&void If work or authorized construction is not commenced within 180
days or,f constnictan NOM a suspended for a period of 1 Bt)days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPUCATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
X Sgnahtre of 0WNER(Must be sinned by the OWNER) �—2-) Date �r
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC IlEALTH 510 C414
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