HomeMy WebLinkAboutBLD2025-00533 - BLD CD Environmental Health Review - 4/30/2025 1 r
.VlrrMuipn 10.3eAU1°Ob771Y Q"ear 9:JIX•l.ae'.•).FISA No: •I���/ t )Q�o,%--6��l�"'3C./_- Permit VL/
w ,,, s,„,\\:. MASON COUNTY RECEIVED
. ; COMMUNITY DEVELOPMENT
_..; .. Permit Assistance Center.Building,Planning APR 3 0 202
' BUILDING PERMIT APPLICATION 615 W. Alder Street m
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:ttewrn a Enn Dahl NAME:RCLS sewers _ I Z
MAILING ADDRESS:322$$312th St MAILING ADDRESS:sa3°Ene Ave NW _ C
CITY:',bon STATE:WA ZIP:1M301 CITY:Ssvrdele STATE:WA ZIP:3tl383
PHONE#1:253'19ayeto PHONE:3ea4713145 CELL: 36P4344)111 t
PHONE#2:X! stges" e 2 .1.5O-5134 _ EMAIL: '°*s' .°°'e m 0 i
EMAIL:i1i0i''Q°°'"C"'ns1 L&I REG#Ro-sea 7asca EXP. 12/ 10' 2f �' Z t
PRIMARY CONTACT: OWNER 0 CONTRACTOR Q OTHER 0 _
NAME-°r"`"""" EMAIL�.wrn I 1 ' 1
MAILING ADDRESS ea3°ErtsAv" CITY***"*" STATE WA ZIPtie3e3 Z
PHONE 4041t40e CELL 30"3'°t't
PARCEL INFORMATION: ICE (-'''
'[ PARCEL NUMBER(I2 Digit Number) 3212230.0003e ZONING Ti
1 LEGAL DESCRIPTION(Abbreviated) LAKE UMERICtc3 LOT:38 FIRE DISTRICT .14 T(1 O
SITE ADDRESS 270E Way TOTegorry CITYSne*** t7 t�
DIRECTIONS TO SITE ADDRESS E Mason Lake Rd to Left on E St Andrews Dr t°Right en E Way to Twomey to address
IS THE PROJECT WITHIN 300 FT OF SLOPES)GREATER THAN 14%: YES❑ NO❑ SNOW LOAD:125 psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check ell that apply):
SALTWATER 0 LAKE 0 RIVER/CREEK 0 POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM 0
TYPE OF WORK: NEW 0 ADDITION❑ ALTERATION 0 REPAIR 0 OTHER n
USE OF STRUCTURE(Brrilora•r•Garage.caaarrrrial Bldg.Es.)Res'denu
IS USE: PRIMARY 0 SEASONAL a NUMBER OF BEDROOMS 5 _._ NUMBER OF BATHROOMS g.ri
HEATED STRUCTURE? YES!Whole Bldg)0 YES(Pan(i)n(R/del 0 NO❑
DESCRIBE WORK hew SFR daylight rambler in lake Lirrrertdr Nei°hbornood
$OUARE FOOTAGE;ryr'nporrd)
1ST FLOOR 119 sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT 1461 sq.ft.
DECK 491. sq.ft. •e(341SR€D DECK 35 sq.ft. STORAGE. sq.ft. OTHER sq.ft.
GARAGE sq.ft. Attached 0 Detached❑ CARPORT sq.ft. Attached 0 Detached 0
MANUFACTURED IIOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
' SEWAGEiSF.WER SOURCE: SEPTIC 0 SEWER 0 r NEW 0 EXISTING 0
PLUMBING IN STRUCTURE? YES 0 NO 0 If vas. such cnnrplered Water Adequmy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NOD EXISTING SQ.FT.0
EXISTING BEDROOMS 0 PROPOSED BEDROOMS 3 TOTAL BEDROOMS 3.__............._.
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.indudeg any easement holder or parties of interest regarding this pooled.The owner or wpm
representative.represents that the information provided is rate and grants employees of Mason Courtly access to the above described property
and stmdure(s)for review and inspection.This permit/application becomes null&void if work or authorized construction is not commenced'Ahin 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 APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
1- COUNTY CODE 14.08.42)
X
eriAl 1)GILt/ 04/29/25
Signature of OWNER(Must be shined by the OWNJ Date
DEPARTMENTAL.REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
.111 PLANNING DEPARTMENT
FIRE MARSHAL I A (�,
PUBLIC HEALTH �— 1 ( lal( S �
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