HomeMy WebLinkAboutBLD2025-00137 - BLD CD Environmental Health Review - 6/3/2025 t Permit No:0L'9R2�'OO(-3 7
.. .„,,,,..,.. MASON COUNTY
`� : COMMUNITY DEVELOPMENT E I V E D
", Permit Assistance Center,Building,Planning
J U N - 2 2025
BUILDING PERMIT APPLICATION 30 2 t
PROPERTYR OWNER INFORMATION: CONTRACTOR INFO UOION: Alderl Street �,
NAME:A(I�4tM')ita'(cow\P NAME:Jat4 RCz(i7�r �c54-"Lil'I�c G rJ
MAILING ADDP.ESS:ZS 3( �CPF� f Ah,V MAILING ADDRESS2.Gy$ � M G•1[ V/24, 0
CITY: G YN'I) caJ STATE:k}, ZIP:9A ,, CITY: �/' Iy, S ATE: a4 ZIP: 7
PHONE#1: 366~gZ2- I b i PHONE: E>O7261137 CELL
PHONE#2: 'yK(,/-0t f(-j A N 1t G' EMAIL: p4 c,fv.J el-el G • C u-
EMAIL: Ad l&GUu/b t1 a y .t c.�•(`t� L&I REG# S/dc- EXP.O�aI)26,
PRIMARY CONTACT: OWNER❑ CONTRACTORS OTHER 0 Q�
NAME 1�1f.(4, J t EMAIL It/ oi<J•JPC®evr t•�'1-cut \
MAILING ADDRESS 2l-,in L;3 WO- (1{,�G' �Y tb ? 7STATE—ESN MENTAL
PHONE CELL 3 E
PARCEL INFORMATION: LT
PARCEL NUMBER(12 Digit Numbcr) 31(2 2 S?D632_. ZONING A H
LEGAL DESCRIPTION(Abbrcviatc ) L. t " 3z.- FIRE DISTRICT L/g/
SITE ADDRESS 1/C� E baiNg O('1 (,{ L�- CITY
DIRECTIONS T99 SITE AII��DDRE S le- o.A. V4l04�� 4 t r�.v c t.M , !
d' E gdtwort-V, r `o a AI RI J he ere �'e./°1l._,
IS THE PROJECT WITHIN 300 FT OF pro,
GREATER THAN 14%: YES❑ NOV SNOW LOAD: psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER 0 LAKEX. RIVER/CREEK 0 POND 0 WETLAND❑ SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEWX ADDITION 0 ALTERATION 0 REPAIR❑ OTHER 0
USE OF STRUCTURE(Residence,Garage,Commercial Bldg.Etc.) S Fie
—
IS USE: PRIMARY 0 SEASONAL NUMBER OF BEDROOMS Z_- NUMBER OF BATIIROOMS
'HEATED STRUCTURE? YES(Whole Bldg)0 YES(Part(s]of Bldg)❑ NO 0
DESCRIBE WORK
SQUARE FOOTAGE:(proposed)
1ST FLOOR /3N sq.ft. 2ND FLOORS, 33 sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK,�U`t' sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE 528 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 0 / NEW ig EXISTING 0
PLUMBING IN STRUCTURE? YESbl NO 0 If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES NOD EXISTING SQ.FT.
EXISTING BEDROOMS 0 PROPOSED BEDRO MS 2- TOTAL BEDROOMS 2--
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
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 O 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
` I COUNTY CODE 14.08.42) Cal`/ram^, /
A / V 20
Signature o 0 (Must be signed by the OWNER) Date
DEPARTMENTAL R EW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL (ler
{ '4 PUBLIC HEALTH 10 '�('Lc C 14W .'!t , 'i
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