HomeMy WebLinkAboutBLD2025-00298 - BLD CD Environmental Health Review - 6/18/2025 MASON COUNTY Permit _
COMMUNITY DEVELOPMENT
•/ ¢ Permit Assistance Center, Building,Planning VC
BUILDING PERMIT APPLICATION R ,8 2025
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: �C�/VFb
NAME:aao.I&"'alI". NAME:Tway t"r"omSemi="t
MAILING ADDRESS:1331 1911'st E MAILING ADDRESS:"N ow*""'
CITY:o- STATE:W" ZIP:9133' CITY:"'mom* STATE:WA ZIP:'b"
PHONE#I:nsrs"n° PHONE:aa4es w CELL:
PHONE#2: EMAIL: EXP O8A025
EMAIL: ^�„gym L&I REG#
PRIMARY CONTACT: OWNER 0 CONTRACTOR❑ OTHER 0
NAME c"."-- - EMAIL'^°'°a"wh-,"
MAILING ADDRESS"'"ter•" CITY 10°+°" STATE sw ZIP
PHONE"'""" CEIL.—
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 44'°°'0°°77 7AN1NG PAS
LEGAL DESCRIPTION(Abbreviated) LANE C13MWAI"1"s7 FIRE DISTRICT'°
SITE ADDRESS t7/Nad'"a CITY rood'""
DIRECTIONS TO SITE ADDRESS Fa°"'us-1°'"''''WA."'""MmACud' .I.A.NMI"1)NCC1Wm"I
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESO NO 0 SNOW LOAD: pst
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE 0 RIVER/CREEK 0 POND 0 WETLAND 0 SEASONAL RUNOFF❑ STREAM 0
TYPE OF WORK: NEW 0 ADDITION 0 ALTERATION 0 REPAIR 0 OTHER f7
USE OF STRUCTURE(Reeide.ce Gmegr.Co.nrrrrialBldg.Ere.)'9.2fO"'" —
IS USE: PRIMARY 0 SEASONAL 0 NUMBER OF BEDROOMS' NUMBER OF BATHROOMS°
• HEATED STRUCTURE? YES rwhde Boo 0 YES clron(sl of Bldg)❑ NO 0
DESCRIBE WORK b*ovomraatwnb* nu4eor"m,
SOUARE FOOTAGE:(,.. )
1ST FLOOR 70° sq.ft. 2ND FLOOR _ sq.R 3RD FLOOR sq.R. BASEMENT cy ft.
DECK'x sq.ft. COVERED DECK sq.R STORAGE sq.ft. OTHER sq.11.
GARAGE sq.ft. Attached 0 Detached 0 CARPORT sq.R. Attached 0 Detached 0
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED'
MAKE MODEL YEAR LENGTH
WIDTII HI-DR(X)MS BATHS SERIAL NUMBER _
ENVIRONMENTAL HEALTH:
' SEWAGFJSEWER SOURCE: SEPTIC o SEWER 0 / NEW 0 EXISTING 0
PLUMBING IN STRUCTURE? YES 0 NO 0 If yes.attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NOD EXISTING SQ.FT."°
EXISTING BEDROOMS° __ PROPOSED BEDROOMS ' - TOTAL BEDROOMS
OWNER danMMdjen that sigi tliesion of naccurIM irIcarnation may result in a stop work order or permit revocation AdtnoM.dgement of such is by
d0Ielure below.I declare eel I tam the owner and I further declare that I am entitled to receive this pemit and to do the work as proposed.I have
al:40W permission from at the necessary parties.including any easement holder or parties of interest regarding this proleri- The owner or legal
representative.represents the the information provided is accurate and wants employees of Mason County access to the above described property
and structures)to review and l,spmtion. This pomnf/apptcabon becomes null&vod C work or authorized construction is not commenced within 180
days or if cons uclbon wok 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 APPUCATION OF 180 DAYS OF MORE WILL CAUSE THE APPUCATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
..--
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Signature of OWNER(Musl,4ybiat,d bythe OWNER) ( Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH Y�I'//Q� 7qm coterrtmc added,
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