HomeMy WebLinkAboutBLD2025-00766 - BLD CD Environmental Health Review - 7/27/2025 r---- 1, 0 -�7(alo
MASON COUNTY Permit No:
COMMUNITY DEVELOPMENT RECEIVED
'^'44r- Permit Assistance Center,Building,Planning JUN 2 5 2025
BUILDING PERMIT APPLICATION 616 W.Alder Street
PROPERTY OWNER INFORMATION; CONTRACTOR INFORMATION:
NAME:Mae 4,Dell?. A F� NAME:/rOb :J Fete- -
MAILING ADDRESS: 3 T MAILING ADDRESS: ..• ►.•
CITY: /M./, STATE:�A ZIP: CITY: vase STATE: tam ZIP:1(J j C
PHONE#1: PHONE: $� Z rSt
EMAIL:PHONE#,;gib o 3�7 a 9ia abi L&I EMAILREG t) * XP,�/Jf/� Crt
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PRIM 'Y 1 I 1 • OWNER 0 CONTRACrORk A THE ❑Pt 6'4��t� Q O
MAILING ADDRESS I Q •} &as LCD( E CITY EMAIL . _ STATE id A ZIP' s'h Z
PHONE 346 d A w w 391_ CELL r=
PARCEL INFORMATION: m
PARCEL NUMBER(12 Digit Number) t�2 2 O Z-S'1-o 1 o 0 6 ZONING • 2
LEGAL DESCRIPTION(Abbreviated) �� FIRE DISTR . D.
SITE ADDRESS PO Ai/ tJA4IDA! Wheel E D CITY6c/ :✓- ✓& • >
DIRECTIONS TO SITE ADDRESS
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IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESO NOX SNOW LOAD:. psr �C�
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check an shot appty):
�` OAS,
SALTWATER 0 LAKE 0 RIVER/CREEK 0 POND 0 WETLAND❑ SEASONAL RUNOFF 0 STREAM 0 Q
TYPE OF WORK: NEW a ADDITION 0 ALTERATION 0 REPAIR 0 OTHER ❑
USE OF STRUCTURE(Residence.Garage.Coaueemwl8ldg.Etc.)
IS USE: PRIMARY 0 SEASONAL 0 NUMBER OF BEDROOMS NUMBER OF BATHROOMS 2
HEATED STRUCTURE? YES(Whole MV 0 YES(Panft)ofBldg) NO
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DESCRIBE WORK 4 >1 �ra1 b song e
SOUARE FOOTAGE:(mewed)
1ST FLOOR_2°6 i sq.ft. 2ND FLOOR 41V sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECKr32. sq.ft. STORAGE sq.ft. OTHER sq.A.
GARAGEe3c0 sq.ft. Attached% Detached❑ CARPORT sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION:
MAKE MtODE I. YEAR _LENGTH
WIDTH BEDROOMS BATHS . SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC N SEWER 0 I NEW 0 EXISTING it
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PLUMBING IN STRUCTURE? I NON !f yes.attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES ' NOD EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 1 TOTAL BEDROOMS t,
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 ern entitled to receive this pernrt and to do the work es 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 4 work or authorized construction is not commenced within 180
l 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 MO IL AUSE THE APPLICATION TO BE EXPIRED.(MASON
DE 14.08.42)
Z.5—_ 4 S_
X
a R n e WNER Date
DEPARTMENTAL REVIEW APPROVED DATE. DENIED DATE TAGS/NOTES/COSDI I IONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTHtOZT— tilik•itc C
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