HomeMy WebLinkAboutBLD2025-00805 - BLD CD Environmental Health Review - 7/8/2025 1
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`0N4x" 5 MASON COUNTY COMMUNITY SERVICES PermitNn:___QjLD2,02.,5_=00ie)0
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Phone I
44)5 �k nelh6:(JM)275 4167•Phone Cutts:(360)457-5269 I
._ni` BUILDING PERMIT APPLICATION JUL 08 2025
rR:orFRT1 OW MtR LFORMATION: CONTRACTOR INFORMATION: 61 Alder Street
NAM Fi3�-t r _ NAME+_tom L4106lyv(}16 --
Vc�rs ssn �t�yy(
\SAIT.1\`(I M)PR'•.SS: tZ10 S� h r �d. MAILING ADDRESS:
CITY:_5_ ( _STATE:W A ': CITY: STATE: tea_._.--
1 PHONE 41:j 1O) 3jL• IOW PHONE(3 DI 74L-L j ELL:
PHONE#2: EMAIL:
EMAIL: L&I REG# ECP._,
PR MARY CONTACT: OWNF.R❑ CONTRACTORE- OTHER❑ • ✓
NAME t1.0 'IP7b1}ti EMAIL_EC4��Or1fa/I/f.�llJvt-Ykhoo
MAILING ADDRESS CITY STATE ZT? 'A� &' P
(OYl't
PHONE CELL ?4?-u({q to 0 cP
PARCEL INFORMATION: FGO �ci`
P.ARCEL SUMMER(12 Digit N, br)32035-YO-9020 ZONING
� LEGAL DESCRIPTION(Abbrcviatcd) FIRE DISTRICT-_____ —
SliLADDRyss 12'W 5t Yhifb,5 a CITY S!u/fir
DIRECTIONS TO SITE ADDRESS
IS 1 tit,PROJECT V.Ii tUN 300 FT OF SLOPE(S)GREATER THAN 14%: YES N0/0/SNOW LOAD:
IS PROPERTY«11HnN 200 FT OF TICE FOLLOWLNG: rtea a aa.7772):
S-ALTR:ATER❑ LASE❑ RIV�R/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW 0 ADDITION I] ALTERATION' REPAIR 0 OTHER I!I
USE OF STRUCTURE(.tax Game Ceeet gar BMy E) Addf n5 ha 441oM —
IS USES._ PRLISARY. SEASONAL❑ NUMBER OF BEDROOMS__ NUMBER OF BATHROOMS L I
FEEATFD STRUCTURE? YES(note Me❑ YES(Pa+sl'J of )0 NO❑
DFSG4.3EWORX mil$ SQ. FT, BATTmROOM TO BA SST-AC tVT
SOUARE FOOTAGE:(,cac7
1ST FLOOR sq.R 2ND FLOOR sq.ti 3RD FLOOR sq,2 ASc B rT sq•L 1
DECK ss.& COVERED DECK sq.f STORAGE sq.>L OTHER sq.3 O
G.AR.A - sq.a.Aid❑ Detached 0 CARPORT sq.ti Attached De: d 0
MANUFACTURED HOME INFORMATION: • *4 COPIES OF WI,FLOOR PLAN REQUIRED*
IAAE MODEL YEAR LENGTH
WIDTH 8MROOMS BATHS SE2IALNIT BER V J Z.
ENVIRONMENTAL HEALTH:
SEWA&-./SEWER SOURCE.• SEPTIC ya SEWcR❑ 1 NEW 0 EXLST LvG 0
4 PLUMBING TN STRUCTURE? YES 0 NO❑ Form
P OUNDATION DRAINS PROPOSED? YES❑I NO2mc WcurFJCSTIGiSQ. c
FT. `
EXISTI2:GBIDROOMS PROPOSIDBIDROOMS TOTAL BEDROOMS J
o wNER e&zoete-pes that s�naslon a(csc ia-ea informslon may result h■sta4 order or pmra rcwcadat A anwledgemca ci sea n h y
slyr'i*ae beb-.e.I dedate the I am the owner and I further declare that lam entitled to receive this peed*and t,do the watt as prt:pesed.I have . _
ob a wed pefmEsc'from aims rw**vary patties,Including any easement holder or putts a(tttetest repardL12 this project.The owner or lesal
rrpcmec.•adve,reprcccs el&the Irformain provided b accurate and prams employees of Mason Gouty access to the above deaaiSed ampetty
are s'rxztKs)'at review mM ins?odon.Tha permttlapp7)=L1on becanes reel&void If wait or a.4nnzed cant uc on is rrt cane. f we.;11 it.)
Gars or if come -al cut:Are-al vrl t Is expended Ice a period of 180 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERT/fT APPLICATIO DAYS OF MORE
COUNTY CODE CAUSE
1 E 4)E APPLICATION TO BE EXPIRED.(MASON
y , 111c(as
e ct ER(Must LA started by the OWNER) Data
I iiL IMP-tfrAL,[i}!T W_V;4 r111iF$(2Y :.1PAT,4'-" j n.E. ) DrvT$`.-TAGS/NOTES:COS-pUiwS _
BUIIDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC}MALTN ry ' t{! - ( A -y't is