HomeMy WebLinkAboutBLD2025-00624 - BLD CD Environmental Health Review - 5/21/2025 Permit No ,�Z -0 4
MASON COUNTY ;t-l.• I.-
COMMUNITY DEVELOPMENT MAY 21 2025
Permit Assistance Center,Building,Planning
BUILDING PERMIT APPLICATION 615 W. Alder Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:lent vii Oe4ilA/IS agcr— NAME: -- - rt1
MAILING ADORE-SS: MAILING ADDRESS: Z
CITY: ('Lo STATE:�k ZIP: y CITY: STATE:_.._._._-.-ZIP:
PHONE 111: 3 VI 1 - `7 5 PHONE: CELL:
PHONE N2: '7j O� ? 0-03 EMAIL
EMAIL: ' 2 LBcI REG M EXP. a/ a m O
— CO' OWNER CONTRACTOR❑ . OTHER❑ t� u• I > Z
NAME
MAILIN DDRE R I CITY L O STATE ZI '""I m
PHONE ' CELL 3 T (q1 - 3 0 tJur, Z m
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 32 033 - II - g o to 0 ZONING
LEGAL DESCRIPTION(Abbreviated) —. FIRE DISTRICT r
SITE ADDRESS qt 55 CaM pf-it G).,tr't- CITY____S_tir,1}'o✓)
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES NO 0 SNOW LOAD:a Cps(
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check alAntappty).
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM Bi
TYPE OF WORK: NEW BS ADDITION❑ ALTERATION 0 REPAIR❑ OTHER (1
USE OF STRUCTURE Garage.C4.r.e.rcief of lg,Ex)
IS USE: PRIMARY(' SEASONAL❑ NUMBER OF BEDROOMS / NUMBER OF BATHROOMS /
HEATED STRUCTURE? YES(WholeBidgl Er YES Mar+Rh ofBWgl❑ NO❑ 1
DESCRIBE WORK CO ns}re.(cho�rt ( 4.9 o4 DPP ""' kars`�f+ keg_ isuutg�
SOUARE FOOTAGE;(prep..t
1ST FLOOR(DA Vsq.ft. 2ND FLOOR — sq.ft. 3RD FLOOR — sq.ft. BASEMENT sq.ft.
DECK ' sq.ft. COVERED DECK —. sq.ft. STORAGE sq.I. OTHER sq.R
GARAGE sq.ft. Attached❑ Detached 0 CARPORT — sq.ft. Asachrd❑ Detached❑
MANUFACTURED HOME INFORMATION: l n_*4 COPIES OF THE FLOOR PLAN REQUIRED'
MAKE _ MODEL^_,J j/4 YEAR LENGTH
WIDTH BEDROOMS _ BATHS ` SERIAL NUMBER
ENVIRONMENTAL HEALTH;
SEWAGE/SEWER SOURCE: SEPTIC or SEWER 0 / NEW re EXISTING 0
PLUMBING IN STRUCTURE? YES NOD /fyes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NO[( EXISTING SQ.FT.
EXISTING BEDROOMS 0 PROPOSED BEDROOMS / TOTAL BEDROOMS
OWNER admoveseges Mat atbrnission of Inseams~ninon may result in a stop work order or permit revocation.Admow sdgemsnt d sudm is by
signature below.I dodges that I am the owner and I father declare**I am settled b receive this pennit and b do the work as proposed.I have
obtained permission from al the necessity parries.Including any easement Wader or pales of ksraat regarding this pcisct The miner or legal
reprssenaave,represents that Ma informalion provided is accurate and grants employees of Mason County doses to the above described property
and sttuekrre(s)for review and inspection.The petmlUappicalbn becomes WI&void if work or authorized ocnsbudlon is rid commenced valhn ISO
days or a cer mimic°work is suspended fora penal d 180 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT AP All N 1 DAYS OF MORE LL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
CODE 14.0442) )
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. Signature of OWNER(Aj be stoned the OWNER) Dote
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL f- v Qp
PUBLIC HEALTH le �CJ� t 0494
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