HomeMy WebLinkAboutBLD2025-00395 - BLD CD Environmental Health Review - 6/10/2025,
MASON COUNTY t LP Oa DD(P 5
Permit No
' COMMUNITY DEVELOPMrift E I VE D
J'` , Permit Assistance Center,Building,Planning
EN�‘ �N BUILDING PERMIT APPLICATION JUN - 6 2025
PROPERTY OWNER INFORMATION: CONTRACTOR INFORRIe\ IO ,Alder Stre-t
vvNAME:1240bt4 GO Ut Cat i P. NAME:
MAILING ADDRESS:9Q%CM Ittpts MAILING ADDRESS:
CITY: tl h STATE:IV ZIP: �y CITY: STATE: ZIP:
PHONE I: 1 a 610-(My q—5 y PHONE: CELL:
PHONE#2: EMAIL: G
EMAIL: L&I REG# EXP._/ /_ fil Z UnnUuu`u'
PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 0 ER� S
NAME Cd V� EMAIL tom., -t 42.1.@� IMO�r`.(ff1M L
MAILING ADDRESS O O CITY . r STATE ZIPC4 rr 2Y (n
PHONE CELL _ - i - mil' 0 t�
PARCEL INFORMATION: /� QnJ�
PARCEL NUMBER(12 Digit Number) 6/al i 37 7 Q- / t)r) ZONING
LEGAL DESCRIPTION(Abbreviated)C I FIRE DISTRICT
SITE ADDRESS W L rnjc,y Iq%}• C ' CITY Al t(fir/
DIRECTIONS TO SITE ADDRESS (I
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO'SNOW LOAD:CO psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all Mai apply):
SALTWATER 0 LAKE 0 RIVER/CREEK 0 POND 0 WETLAND❑ SEASONAL RUNOFF❑ STREAM 0
TYPE OF WORK: NEW'. ADDITION 0 ALTERATION 0 REPAIR❑ OTHER X
USE OF STRUCTURE(Residence.Garage.Commercial Bldg.Etc.) leSt��ee
IS USE: PRIMARY' SEASONAL 0 NUMBER OF BEDROOMS NUMBER OF BATHROOMS a•5
HEATED STRUCTURE? YES(whole Bldg) YES(Partial of Bldg)❑ NO❑
DESCRIBE WORK
SQUARE FOOTAGE:(proposed
1ST FLOOR 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 0 Detached 0 CARPORT sq.ft. Attached 0 Detached 0
MANUFACTURED HOME INFORMATION: *4 COPIES OF TTaF BI R PLAN REQUIRED*
MAKE TIQV i MODEL e9,$34 YEAR �� / cNIGTH .5 4
WIDTH 4I0 BEDROOMS_ _ BATHS .s SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC SEWER❑ / NEW❑ EXISTING
PLUMBING IN STRUCTURE? YES1SL NO 0 If yes,attach completed Water Adeq acy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 N� EXISTING SQ.FT. It 4t
EXISTING BEDROOMS y PROPOSED BEDROOMS ' _ TOTAL BEDROOMS
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 prov ded 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 fora period of 180 days.
PROOF OF CONTINUATION OF •:K ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLIC. •.' OF t a -YS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
i -,COUNTY CODE 14.08.42)
X
S' ature of 0 /ER(Must be sI_ned by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH agr 1 rZ I vl Cl'1.._ akk
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