HomeMy WebLinkAboutBLD2025-00715 - BLD CD Environmental Health Review - 6/11/2025 $l D 2ou--cam F/S
MASON COUNTY Permit No: BLOR E ED
COMMUNITY DEVELOPMENT JUN
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y 11 2025•.
NC, Permit Assistance Center, Building,Planning
BUILDING PERMIT APPLICATION 615 W.Alder Stteet
•PROPEB� Y OWNER INFORMATION.
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n v L CONTRACTOR INFORMATION':
NAME: 1 ( kP Mt.'s 5 h L e; vats NAME: ,3 Gr r�rt.v a \rw asL r _
MAILING ADDRESS: PO Roy I MAILING ADDRESS:
CITY: 13Utr STATE: (ATIAZIP:CIk3ZZ CITY: STATE: ZIP:
PHONE#1: 2 f 3- 3"7-7- CD-7 qk PHONE: CELL:
PHONE#2: EMAIL:
EMAIL: WI ✓fie I'VLCshkJ) Cjq,hcae t,LY L&I REG# EXP._/_/ C''
PRIMARY CONTACT: OWNER X. CONTRACTOR❑ OTHER 0 g
1%1 t-J
NAME EMAIL
MAILING ADDRESS CITY STATE ZIP
PHONE CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) I 22-11 11 -5O -9 I?j 9 ZONING A.,DS
LEGAL DESCRIPTION(Abbreviated) � g FIRE DISTRICT
SITE ADDRESS ( Q o (�l LCL ld 1 (2-A CITY EllI l/
DIRECTIONS TO SITE ADDRESS I--prn pS4erd --{---b ic)I et ( t
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES0 NO El: SNOW LOAD: psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE 0 RIVER/CREEK 0 POND 0 WETLAND 0 SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW®' ADDITION 0 ALTERATION 0 REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence,Garage.Commercial Bldg,Etc.) LQG,'1 i?n Cm,"
l," Q
IS USE: PRIMARY . SEASONAL 0 NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole Bldg)E' YES(Part[s]ofBldg)0 NO❑
DESCRIBE WORK ! �-�' ,�1U S- a" j(p•1/I 17,5 O O 0
SQUARE FOOTAGE:(proposed) ,� Y Z 11 L I.D4v-lt �wY
1ST FLOOR 1323 sq$. 2ND FLOOR.� sq.ft. ' 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK �= sq.@. STORAGE sq.ft. OTHER sq.ft.
GARAGE 110C) sq.ft. Attached rg.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 0 SEWERg / NEW[a EXISTING 0
•PLUMBING IN STRUCTURE? YES. NO❑ Ifyes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES ig NOD EXISTING SQ.FT.EXISTING BEDROOMS PROPOSED BEDROOMS 3-1i TOTAL BEDROOMS .t17
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 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 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
PERMIJ APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
•
t//1COUNTY CODE 14.08.42)X 4Signature of OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW' i4PKRctyp .DATE . DENIED DATE< TAGS/NOTES/CONDITIONS �:.
BUILDING DEPARTMENT
PLANNING DEPARTMENT •
FIRE MARSHAL ,p
PUBLIC HEALTH ANO4-, � , AV V vim/ - f
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15074 qr. oi. . '�-•v.sex. e...---o. ,.b„ WASHINGTON FEDERAL SAVINGS REMAINING IMPROVEMENTS
a,,, 8 1`� Ivilni-siai ru •"1' cio iL'GKA GEfiSTNAh•Y EXHIBIT
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