HomeMy WebLinkAboutBLD2025-00467 - BLD CD Environmental Health Review - 4/15/2025 MASON COUNTY Permit No: bLp2025-ct.ya5-7
COMMUNITY DEVELOPMENTE C E I VED
Permit Assistance Center, Building,Planning
BUILDING PERMIT APPLICATION APR 1 5 2025
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATIO�N:W, Adder Street
NAME: f J - 02.10 FTS NAME:
MAILG ADDRESS:. O, 13C) 73/(43 MAILING ADDRESS: P- " " n N M F^ �A L
CITY: I ALL()P STATE:&A ZIP: '73 CITY: ST V 1 r u J '
PHONE#1: Z$3-(r7/-S209 PHONE: CELL:
PHONE#2: EMAIL: H tA/LT H
EMAIL:SCi2Oa 1 J(. 1-1✓Z , Co M L&I REG# EXP. /
• PRIMARY CONTA T. OWNER E CONTRACTOR❑ OTHER❑
NAME �E►J fZOF-rs. EMAIL OPT i-(u rt
eor .
MAILINGADDRESS�O Sox 3/t5-3 CITY AudP STATE A ZIP g4373
PHONE Z5-3-Io7S-5-l07.3 CELL 253'4,7V - 5-Z07 m
PARCEL INFORMATION: m
PARCEL NUMBER(12 Digit Number) 3 ZO Z l 5-2,O t tl f 5 ZONING aStaatall4 L
L co
'SNQtft >--3f�ll m LEGAL DESCRIPTION(Abbreviated
w51I14�fid taw Lc, ej FIRE DISTRICT / 17
SITE ADDRESS /SO E KII%C}STb/� CITY_SNg.LToA
DI ECTIONS TO SITE ADDRESS NfreY 3 AI -1-0 74R11c tl o.RT TO el•usrvin..), gr 7o
F1n4 Ri r DR, Lccr ro gie.3e.51v14 I�a-r, Rr rel /SoC.
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES NO® SNOW LOAD:_psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE 0 RIVER/CREEK❑ POND❑ WETLAND 0 SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW 0 ADDITION❑ ALTERATION 0 REPAIR D OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc) Res I DL N co r
IS USE: PRIMARY E SEASONAL 0 NUMBER OF BEDROOMS Z- NUMBER OF BATHROOMS Z.
HEATED STRUCTURE? YES(Whole Bldg)A YES(Part[s]of Bldg)❑ NO 0
DESCRIBE WORK PCPLA-e-e- /YIf1.1V. 14D"i
SOUARE FOOTAGE:(proposed)
1ST FLOOR/D3 41 sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK_ sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft. Attached 0 Detached 0 CARPORT sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE ^ i'7 MODEL PX/`/G A YEAR !3 LENGTH 42-'
WIDTH �$ BEDROOMS BATHS 2 SERIAL NUMBER H Dl rj')3(o As
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC B SEWER 0 / NEW 0 EXISTING E
PLUMBING IN STRUCTURE? YES 0 NO 0 If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NOIg EXISTING SQ.FT. F O 3 q
EXISTING BEDROOMS 2 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 ail the necessary parties,including any easement holder or parties of interest regarding this project. The owne•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&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 0 CONTINUAT N OF ORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERM LICAT OF 1 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
X 0S/Z�
Signature NE Must be signed by the OWNER) Date
DEPARTMENTAL REV EW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL k ---;PUBLIC HEALTH 5(C(JI?c AA co4412
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