HomeMy WebLinkAboutBLD2025-00771 - BLD CD Environmental Health Review - 7/7/2025 . Permit No:,OL..1/`5't 177I
MASON COUNTY „_ ,• ' —)
COMMUNITY DEVELOPMENT RF
Permit Assistance Center,Building,Planning 111�t 2f. ��aS —
BUILDING PERMIT APPLICATION JV U •e,gt
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMA 1:v • ' ' • "' ✓G �^
NAME: ��r\Q� GI mm1�S NAME:I &(�r\C.S CA3 err 4�T 4, a "c
MAIL G DRESS: MAILING ADDRESS: �j
CITY: STATE:\JV� ZIP: CITY:?1�rint+4+p.yn S ATE L ZIP: G ,—,
PHONE#1: Z.A.lP— 31"A PHON CELL: �t(o -6 Ze Fs7
PHONE#2: EMAIL:
EMAIL:e, yis. „5(@C f_YY.I.iv,1 -&I RE #kk0 FFQ�11 Q . I /12/
PRIMARY CONTACT: O�R 0 CONTRACTOR 0 1@ OTHER1 I ��
NAME A)I 2N/ /tn/IP/>,e'1 EMAIL d a7 qd •
MAILING ADDRESS 20 Wr. { ai{i1P.rs D'- 3 CITY 5 r STATE WA ZIP ciSSa
PHONE CELL 6O b lir
PARCEL INFORMATION: ENVIRONMENTAL
PARCEL NUMBER(12 Digit Number) LLI 13'Z 2S oOTO ZONING • HEALTH •
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT
SITE ADDRESS 61 . AAA; Way CITY Gr lfie,v✓
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESO NO 0 SNOW LOAD:__psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE❑ RIVER/CREEK 0 POND❑ WETLAND❑ SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW ADDITION❑ ALTERATION❑ REPAIR 0 OTHER f 1
USE OF STRUCTURE(Residence,Garage.Commercial Bldg,etc.) IDS C6"
IS USE: PRIMARY SEASONAL 0 ,NUMBER OF BEDROOMS II NUMBER OF BATHROOMS 3
HEATED STRUCTURE? YES(whole Bldg) _ YES(Part I V of Bldg) NO 0
DESCRIBE WORK
SQUARE FOOTAGE:(proposed) /
1ST FLOOR 1 646 sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT I6$O sq.ft.
DECK sq.ft. COVERED DECK_b'asq.ft. STORAGE sq.ft. OTHER sq.it
GARAGE S55 sq.ft. Attached 0' 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 10 EXISTING 0
PLUMBING IN STRUCTURE? YES NO 0 Ij es,attach completed Water Adequacy Form
PERIMETER/FOUNDATION r • l S PROPOSED? YES NO❑� EXISTING SQ.FT. v
EXISTING BEDROOMS , PROPOSED BEDROOMS 9 ✓ "I OTAL BEDROOMS
OWNER acknowledges that s bmission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by
signature below.I dedare that I am the owner and I further dedare that I am entitled to receive this penult and to do the work as proposed.I have
obtained permission from all the necessary parties,inducting any easement holder or parties of interest regarding this proleet 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 nuN&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 F WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PE IT APPLICATION 1 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
x �� �L.Q
Signature of OWNER st be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL �,�� C A d9,—� �
PUBLIC HEALTH '1Js 1 {� �
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