HomeMy WebLinkAboutBLD2025-00473 - BLD CD Environmental Health Review - 4/18/2025 .,.
Permit No: 1,.O 2025- OOg 1 3
MASON COUNTY
COMMUNITY DEVELOPMENT RECEIVED
Permit Assistance Center,Building,Planning
BUILDING PERMIT APPLICATION APR 17 2025
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMAT `5 W.Alder
NAME:N IGk' R�y„vottos NAME:
MAILTU GJ A'DDR SS: Ao&a, L133 MAILING ADDRESS:
CITY:YTZ L'/N1 STATE: ZIP: CITY: STATE: ZIP:
PHONE 41: ZOO 53S Cx(Z-V PHONE: CELL:
PHONE 42: EMAIL:
EMAIL:N r 4«IerI,&T REG 4 EXP. / / , �j
PRIMARY_CO_ NTACT; OWTS4 , CONTRACTOR 0 OTHER 0
NAME fI'>4R4. 4 a✓&` EMAIL 2. p
MAILING ADDRESS CITY STATE ZIP Q cs
PHONE CELL
PARCEL INFORMATION: L�
PARCEL NUMBER(I 2 Digit Number) Z2. l2 l '2. - TO � / ZONING
LEGAL DESCRIPTION(Abbreviated) 1' or sP4e 2CX 4iM 6 FIRE DISTRICT
SITE ADDRESS Ow U 1 i CITY (11144-PLJ i Ew
• DIRECTIONS TO STTE ADDRESS 1J Y 3 TD AN firrMY 7v CgNTEQt '1
1-7) L co oiy',ix.) , ism P/'o� o ev 'FT"
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO? SNOW LOAD: psf
TS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE 0 RIVER/CREEK 0 POND❑ WETLAND❑ SEASONAL RUNOFF 0 STREAM 0
i
TYPE OF WORK: NEW/ ADDITION❑ ALTEERAATTI�ION 0 REPAIR 0 OTHER 0
USE OF STRUCTURE(Residence.Garage.Commercial Bldg,Etc.) �.sf�It
IS USE: PRLVIARY2SEASONAL 0 NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS 2-
HEATED STRUCTURE? YES(WholeBldglie YES(Parr/s)of Bldg)0 NO❑
DESCRIBE WORK N k-vJ Casisp v-TJ t?I,
SOUARE FOOTAGE:p (proposed)
/`e
1ST FLOOR I sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.fl.
DECK L4' sq.ft. COVERED DECK 7 ii sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE boo sq.ft. Attached Detached 0 CARPORT sq.ft. Attached 0 Detached 0
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC SEWER❑ / NEW% EXISTING 0
PLUMBING IN STRUCTURE? YE5erf NO❑ If yes,attach completed Water Adequacy Form
PERIMETERJFOUNDATION DRAINS PROPOSED? YE NOD EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS 3
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/applcation 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.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLI TION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
x / COUNTY CODE 14.08.42)
A . /2 4/dL 2o2s
Signature OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH 06 C (ZC V' o`E'' A
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