HomeMy WebLinkAboutBLD2025-00276 - BLD CD Environmental Health Review - 3/11/2025 MASON COUNTY Permit No:e2L9g1 �7C�
COMMUNITY DEVELOPMENT
Permit Assistance Center, Building,Planning MAR 1 1 2025
BUILDING PERMIT APPLICATION 615 W. Alder Stre t
. PROPERTY OWNER INFORMATION: CONTRACTOR[ 'd INFORMATION:
"NA .his _ p �ou4? We"t L /111-4- pg(eJF-II i6-
MAILING ADDRESS: e)02.... 4:( I. MAILING A RESS: .G LIP: <
CITY�,4/fr` STATE: ZIP. CITY: STATE: ZIP: i.S �q
PHONE#1: D 521 1 I 1 D PHONE. CELL: ,Q �J
PHONE#2: EMAIL G a Q. e /hSlid-CBK/l FC /
EMAIL' O. ,y VA( ,4011/1 L&I REG15I((i �. 5'I-t" EXP. t /It/2A G <32
PRIMARY CONT OWNER❑ CONTRACTOR ' OTHER El '0
NAME EMAIL
MAILIN ADD SS ill cv 1TY I)LYatpr4 STATE _ZIP__
PHONE CELL L 2 - _ MENTAL
PARCEL INFORMATION: �+ /ENV'RO
PARCEL NUMBER(12 Digit Number) 2�b`J (jOdd''2- ZONING /� HEALTH
/ SALT H
LEGAL DESCRIPTION(Abbreviated) 7 U 7/J�,44 2' FIRE DISTRICT
SITE ADDRESS t 9 � `�.a r�r f I
CITY S LxL1fiJ
DIRECTIONS ������rrEE ADDRF S ���/ f� 7000/EJ ZL
k4l' C.l akG j oil, I7185(944 '
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO ff NOW LOADSrpsf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
.SALTWATER 0 LAKE❑ RIVER/CREEK❑ POND 0 WETLAND 0 SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW[ADDITION❑ ALTERATION O. REPAIR❑ OTHER At, 4
USE OF STRUCTURE(Residence.Garage.Commercial Bldg.Etc.) /t&-
. IS USE: PRIMARY SEASONAL 0 NUMBER OF B DROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole Bldg)0 YES(Parf(sJ of Bldg)0 NO❑
DESCRIBE WORK Ib j U- AIM,'z. - 'Li C1.
. SQUARE FOOTAGE:(proposed)
•
1ST FLOOR/ K'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❑ Detached 0 CARPORT sq.ft. Attached 0 Detached 0
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE *4 y72/41 MOd S-rf_7�t!(r AL t-Ilf1S '.YE�4�_ LENGTH___?
WIDTH_ Up`— BEDROOMS 2. BATHS L- SERIAL NUMBER 7 6,0
ENVIRONMENTAL HEALTH: i1
SEWAGE/SEWER SOURCE: SEPTIC[�SEWER 0 / NEW EXISTING]Q
PLUMBING IN STRUCTURE? YES NO 0 Ijyes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NO EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 2— TOTAL BEDROOMS - '
OWNER acknowledges that submission of inaccurate information may result in a stop work order a 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 ed property ,
and structure(s)for review and inspection. This permitlapptcation becomes null 8 void if work or authorized construction is not commenced within 180
days or if construction work is suspended for a period of 180 days.
P CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
P EATi OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42) •3 / -/ 2
X n `{/
Signature of OWNER(Must be sinned by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL nI` � �'Ld4-- C
PUBLIC HEALTH ' 1M-- CI1 -4 -S
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