HomeMy WebLinkAboutBLD2023-00890 - BLD CD Environmental Health Review - 8/8/2023 MASON COUNTY Permit No:
COMMUNITY DEVELOPAW . . 890
Permit Assistance Center.Building,Planning JUN - 1 2023
BUILDING PERMITAPPUCATION�l 5 W. Alder Street
PROPERTY OWNER,t INFORMATION: CONTRACTOR INFORMATION_
NAME: eIMH t1Ov*e s tnc NAME:f tiQ- s[tJi t3 AP •
MAILING ADDRESS: 300o C[lJailite) 120 MAILING L): ch.. AU
PHONE iaia- STATE.? ZIP:379d/ CITY:C %f 4 STATE:Wit ZIP: W73I G O 810^
PHONE#I: 3W -g7g-72.76 PHONE: _ c CELL L3
PHONE#2: EMAIL:/y,i,;..a er,,,,,, Inlet(VA / RECEIVED
EMAIL:Drr%tk.!t«.keelgookip.tt.cedV1 L.841 PEG# . / /
PRIMARY NTA OWNER 0 CONTRACTOR OTHER❑
NAME trait t EMAIL ►Kc� AstedaugA messfle-
MAILING ADDR'SS 11 Al) CITY a STATE ZIP tRY3J
PHONE 3 WI -2f t-O?pg CELL
PARCEL INFORMATION: ENVIRONMENTAL
PARCEL NUMBER(12 Digit Number) 310 2.5-__St) 0 0 O G/! ZONING H E A{LT H
LEGAL DESCRIPTION(Abbreviated) 'ri 7 ex. AA.) S *du $ FIRE DISTRICT-------
SITE ADDRESS S';s 14C/ tAd4 46 cTTY S1'eJMn
DIRECTIONS.TO SITE ADDRESS
IS THE PROJECT WITHIN 30i FT OF SLOPE(S)GREATER THAN 14% YES❑ NOX SNOW LOAD: psf
IS PROPERTY WITHIN 2N FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE D RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK; NEW] ADDITION❑ ALTERATION❑ REPAIR❑ OTHER Q
USE OF STRUCTURE(Arsidesre.Garage,Commercial Bldg.Etc-) S•C/41 ce_
IS USE: PRIM.ARY'$ SEASONAL❑ NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS 2-
HEATED STRUCTURE? YES(WhaleBl t YES(P js ojBiig)❑ N
DESCRIBE WORK We..) 1�'I+k1t t��4ch�t►'�s --e eu� � i stce e.v►7
SQUARE-FOOTAGE:
t ST FLOOR MS sq.ft ZND FLOOR sq.ft 3RD FLOOR sq.ft. BASEMENT sq.IL
DECK nit.,sq.ft COVERED DECK sq.ft STORAGE sq.ft. OTHER sq.ft-
GARAGE sq.ft. Attached❑ Detached N CARPORT sq.ft Attached❑ Detached n
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE C S Mrbng0( MODEL 72.1em 2fitle AMU .YEAR 202-3 LENGTH Siw
WIDTH 2.7 BEDROOMS BATHS 2 SERIAL NUMBER TOO
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: St:Y 1 IC$ SEWER U / NEW A EXISTING
PLUMBING IN STRUCTURE? YES ja, NO❑ !f yet.attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NOgir EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 3 TOTAL BEDROOMS 3
dWItER adaiowtedpea that aubmisafon et kiaccisate Information may result in a amp work order or permit rewatlon.Admordedgament of such is by
signature beim.I declare that I am the owner and I further declare that I ern added to receive this permit and to do the work ea proposed.I have
obtained permission from all the necessary parties.including any easement holder or parties of interest regarding ads project. The owner or beat
representative.represents that the;Mormedon provided is accurate end y.er,lh,employees of Mason County access to the above described property
and sirucmrejs)for review and lrctpeeton.This pennlUapprIcatlan becomes nut d void it work or mtthorzed construction is not commenced*thin 180
days or if corrabrdUon work is suspended for a period of 180 days.
PROOF INUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERM PLICATION OF 180 DAYS OF MORE WLL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08,42)
Signature c OWNER(Yost be signori
bytfte OMYNER} Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE .TAGS/NOTES/CONDJTIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL PUBLIC HEALTHfi i ICJ(-Ze n X/ 1 eA\ S r5PQ ,
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