HomeMy WebLinkAboutBLD2025-00332 - BLD CD Environmental Health Review - 5/19/2025 J
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MASON COUNTY RECEIVE
COMMUNITY DEVELOPMENT n
0Permit Assistance Center,Building,Planning Permit No: 11 MAR 1 8 2025 ./ID 9�° %
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BUILDING PERMIT APPLICATION nG �,
615 W. Alder Skeet
PROPERTY OWNER INFORMATION: I CONTRACTOR INFORMATION: <1% 0
NAME: V1CAt1G(-in k-/iC EL 1,0 ft NAME: I ,1 Ai(t t Nt fS
MAILING ADDRESS: Z o ,A j wsPtA Nowt'," Oe MAILING ADDRESS: ()O a,X 'X'I 1
CITY: C 11v` - STATE: sr*, ZIP: 'i efS`/f CITY: E.1 hn a STATE: tolA ZIP:: q 05 (
PHONE#1: (n)• 33i,- Z t1 W?.I S$ PHONE:140 (At CELL:3t..) C1'1`1 a-1 SL
PHONE#2: 3to0- y1}S- 335'-1 EMAIL: obtrcK a 1�Li1'sou.Ia*"CI_Con^
EMAIL: lilt eke,(1;0{-f z3 e 7wt A Cofes L&I REG# NI L N N.4"7bctS 3 EXP.04/Z3/243244
PRIMARY CONTA T: OWNER K CONTRACTOR 0 OTHER m 0
et1� -�NAME 1 A F �tl" E R.°k` EMAIL I,C.)Cl f l 2�� yki103 w t`^ D Z
MAILING 3A'DDRESS f\'+ STATE %-J \ ZIP 1 SS'j(
PHONE y(GU - 3 L(C CELL J - 'bD - 3
PARCEL INFORMATION: = �mr
PARCEL NUMBER(12 Digit Number) '3 2o Zoe I o 11-,1 3 ZONING 12.9...6 L
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT 4 D
SITE ADDRESS C A 13 sc.- �i r'.(t:u t Lnl CITY S Htt M N r-
DIRECTIONS TO SITE ADDRESS 1-sun on -V('w I 1 r a^. Lj.ne . (u,\1-i n0C 5l+-A t t Pa55 gNk con
(4k , ,t.).ett COAS a 61c14,t ;,•W facce.l.
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESO NO CSI SNOW LOAD:j2Spsf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply)
SALTWATER 0 LAKE 0 RIVER/CREEK 0 POND 0 WETLAND RI SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW' ADDITION❑ ALTERATION 0 REPAIR 0 OTHER 0
USE.OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc) R eS1C1 G'1C e IS USE: PRIMARY SEASONAL❑ NUMBER OF BEDROOMS 14 NUMBER OF BATHROOMS Z-S
HEATED STRUCTURE? YES(Whole8tdg)$' YES(Part(/of fttdgj 0 NO❑
DESCRIBE WORK Nev.) RGSwde4n,V1•.1 (ciyo Sr I.-Ve+'^4--
SOUARE FOOTAGE:propoteal
1ST FLOOR 1"1140 sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK 3(.2.- sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE r'O ) sq.ft. Attached 4 Detached❑ CARPORT sq.ft. Attached 0 Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR_ LENGTII
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC 0 SEWER 0 / NEWpi% EXISTING❑
PLUMBING IN STRUCTURE? YES r+ll NO 0 lives.attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES Va NO❑ EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS L1 TOTAL BEDROOMS tl
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 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 descnbed property
, and structures)for review and Inspection. This permiVappl cation becomes null&void d work or authorized construction is not commenced within 180
days or/construction work a suspended fora period of 180 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
1 X ---' -e-------- -e-'"- - '''!-77777- 0 3( I I i V.,15
1 `Signature of OWNER(Must be ipned by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL G'� �
PUBLIC HEALTH Otr )k �/
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