HomeMy WebLinkAboutBLD2025-00815 - BLD CD Environmental Health Review - 7/14/2025 •
,gam .. MASON COUNTY Permit No:�IC/I �U� ��
COMMUNITY DEVELOPMENT .6 '`\
„/. �'' Permit Assistance Center, Building,Planning `�"
BUILDING PERMIT APPLICATION ' `\
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: pi/filt<<I(.f 4 li NAME:8tu Alciai -il4I 5�/AlL f-L°
MAILIN ADDRESS:,,,,fir
/,0Y MAILING ADDRESS: It ,IC l a,v 3
CITY: Ij44! to STATE:(,�,G¢ ZIP. .c77t.c CITY:01, LL/�tA STATE:\.u5 ZIP:`�d���3
PHONE#1: 60 - Z,) 2.z3l' PHONE:3(f) 7 2 CELL: Sg1,440-
PHONE#2: 6 ---2 ‘ b EMAIL: RAC / v ill/ r e 640
EMAIL:bu C4tl,,u4 L j CV /AA S,(1.CoLM L&I REG# 4 XP./// //_24 C
PRIMA Y CONTACT:_ OWNER CONTRACTOR[� OTHER_ / / — g
NAME jl Ll/ I'u l LI�C./44A EMAIL 1711/ NC/ilkAine ldl/�(r m
MAILING A DRESS c ,�' CITY �j't�# r/t STATE II-4- ZIP ir.C) Z .---
PHONE
5p/i 2 ' ^2-7-74._ CELL .,4 -/// — 40 v o
1--.)
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) j'2O 2Z�-2 9.0O 2-2-_ ZONING /2''t
LEGAL DESCRIPTION(Abbreviated) /j L,Lt 3D w GD/ 2 FIRE DISTRICT
SITE ADDRESS CITY
DIRECTIONS TO SITE ADDRESS C /
bkN#S4/4 a 7 1. / emu' 77
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESO NO"SNOW LOAD: psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER 0 LAKE 0 RIVER/CREEK 0 POND 0 WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW 0 ADDITION 0 ALTERATION❑ REPAIR❑ OTHER le
USE OF STRUCTURE(Residence.Garage.Commercial Bldg.Etc.)
IS USE: PRIMARY 0 SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(WholeBldg)❑ YESES(Part[s]of Bldg)0 NO 0
DESCRIBE WORK #D�/1 /-kTi
SOUARE FOOTAGE:(proposed)
1ST FLOOR(.7`l 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❑ CARPORT sq.ft. Attached 0 Detached❑
MANUFACTURED HOME INFORMATION:
G� /
12j'i
MAKE /Alt/ MODEL aiy,wrtifele/uw> YEAR /5/ S LENGTH___
WIDTH ZP BEDROOMS 3 BATHS 2- SERIAL NUMBER Die-0 2 4,3 w.A.
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC SEWER❑ / NEW((ii/"..--- EXISTING 0
PLUMBING IN STRUCTURE? YES 0 NO❑ If yes.attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NOI�I EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS Js TOTAL BEDROOMS P
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/application becomes null&void if work or authorized construction is not commenced within 180
I days or if construction work a suspended for a 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)
X 672- /ZS
lure of 0 ER Must be sign by the OWNER) ! Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL J
PUBLIC HEALTH J 1 l7 �' 0\4CM AF) C
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