HomeMy WebLinkAboutBLD2025-00524 - BLD CD Environmental Health Review - 4/30/2025 Permit No: i?,Lp2O2S- Q 652A
.x.�. MASON COUNTY
COMMUNITY DEVELOPMENT RECEIVED
Permit Assistance Center,Building,Planning
BUILDING PERMIT APPLICATION APR 2 9 2025
PROPERTY OWNER INFO RMATION: CONTRACTOR INFORMATION615 w i
NAME: ttliVIr°F fu�%0/11-ele ,Sha f Y NAME: nJl IL 13 Ui Ia.ec,, NW .
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MAILINOADDRESS: 57 Q t• tc� ,A;S .Ar- MAIL 0 ADD SS: N1 CSi ll 2
CITY: 94.p\1-y/k, STATE: WA ZIP: 14151n,i' CITY: STATE:w,A ZIP: 3g 3
PHONE#1: PHONE: D• - I CELL:
PHONE#2: EMAIL: \f vice014,a N r rs e 14 .C'O/YL-
EMAIL: L&I REG# ' eUe,C Z' —6) EXP. 04101 /
PRIMARY CONTACT: WNER 0 CONTRACTOR g2 OTHERR0
NAME TQ� y�Pdi"v CStOk Aufld"VTNO EMAIL 0 . }� I t'Sdg-1:ve •(0/Y✓
MAILING ADDRESS 2/11 b)�� J 1piock)r✓L HMI) KG1 id 2- CITY te STATE atil ZIP I! 'tc
PHONE:AA O609'7311 CELL
PARCEL INFORMATION: � lo'p�
PARCEL NUMBER(12 Digit Number) 3 (Z 7 — (-- by Z7 Z ZONING C Q
LEGAL DESCRIPTION(Abbreviated FIRE DISTRICT FAG ���s
SITE ADDRESS 510 Sd YIQIYI' c}S ....i), CITY ✓r �`O
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO❑ SNOW LOAD: psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER 0 LAKE 0 RIVER/CREEK 0 POND❑ WETLAND 0 SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW 0 ADDITION rog ALTERATION 0 REPAIR 0 OTHER rI
USE OF STRUCTURE(Residence,Garage.Commercial Bldg.Erc.) ROS1d.(YICe -t (//aVQ le
IS USE: PRIMARY in SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
I
HEATED STRUCTURE? YES(Whole Bldg)❑ YES(Part(s/of Bldg)( NO❑
j DESCRIBE WORK aeict I,64,1 I • a t
41 SOUARE FOOTAGE:(proposed)
1ST FLOOR gk Lt sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT Spit_sq.ft.
DECK 1(i i sq.ft. COVERED DECK £5) sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE ZQ Q 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 / NEV ' EXISTING
PLUMBING IN STRUCTURE? YES'S NO 0 If yes.attach co pleted Water Adequacy Form
i ' ' PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NOD EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 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 cwner 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 APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
i
, 4,,,,AOUNTY CODE 14.08.42)
Signature of Oz§e,4
(Must be piqued 4'i-he WNER) Date
i
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT FIRE MARSHAL
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