HomeMy WebLinkAboutBLD2023-01447 - BLD CD Environmental Health Review - 12/8/2023 a r Permit Nod/�
MAsoN COUNTY REC / 7
COMMUNITY DEVELOPMENT
IMFPermit Assists meCenter,Ba1MImPhMln, NOV 30 2023
BUILDING PERMIT APPLICATI NN, AldEfWM MENTAL
TPROPERTY OWNER INFORMATION: CONTRACTOR
ME: �.OatR.I,96 INFORMATION: HEA TH
MAILING ADDRESS: ( MAILING ADDRESS: O 749
CTPY(A11...JwP STATE:i(�_Z :9arsc CITY: M STATE:fJA 21P:v8sy/
PHONE#1: 3J.o-S -ml P19 PHONE a960Ytt CELL:
PHONE#2: MAIL
EMAll,:�Ptilyati LA@l�6fuw1/.[w¢.. L&I REG#N1t1aIN644? o- EXP.-LIELI�PRIMARY CONTACT: OWNER[] CONTRACTOR[I OTHER❑ Elm
NAME was Qg ss EMAIL DEC 0 8
MAILINGADDRESS IC�O N.Coln... SuB.0 *,So CITY4Ou iwO/ SPATE WA. ZIP 2023
PHONE SA.n.TYl9 -Lt9I_ CELL
PARCEL INFORMATION: I RECEIVED
PARCELNUMBER(12INpt Numbs) 9A3096 II007LeaeD if- ZONING
LEGAL DESCRIPTION(Abblgrisud) FIRE DISTRICT J
STD?ADDRES310TC k. CA S� f 1�2. CrrY L11I(un.1P
DIRECTIONSTOSPTEADDRESSiew, naMaA 'FD Cdnwt,_St1e /�9�,L/�
ISTHEPROJECTWITHIN300PFOFSLOPE(S)GREATERTNAN14%: YES[] NO� SNOW LOAD:Jkf
ISPROPERTYWITION201TOFTHEFOLLOWING: (i'FerJ.nav oPPry):
SALTWATER❑ LAKE❑ RTY CREEK❑ POND❑ WETLAND[] SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW Nr ADDPHON[] / TERATION❑ REPAIt[] OTHER II
USEOFSTRUCTURE(a«awccuege.Cbmmen &4Fra)ISUSE: PRIMRY SEASONAL❑ NUMBER �j ! M � NUMBEROFBATHROOM Z
HEATEDSTRUCIJRE? NO[]
DESCRIBE WORK I7
SOUARE FOOTAGE:/P,,—ti //////,�3
IST PLOORA27-L eq.ft 2 1`1.30R .fl 3RD FLOOR sq.ft BAEE64NT sq.R
DECK_eq.ft. COVERED DECK Zy5 Z sq.R SPORAGE N.fl OTHER_sift,
GARAGE V07 eq.ft Alsmhed)k Dslm iha CARPORT W.ft AmchM[] LMaAa[I
MANUFACTURED HOME INFORMATION: ed COPIES OF THE FLOOR PLAN REQUIRED`
MAKE MODEL YEAR LENGTH
WmTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGFISEWER SOURCE: SEPTIC SEWER❑ / NEW}Pry'� EXISTING❑
PLUMBING IN STRUC URE? YESK NO[] lfw,aaach w?zv%ed Wa aAdequary Form
PERNEIERT01bfDATTON DRAMS PROPOSED? YESK NO[] EHSI'INGSQ.".
EXISTMG BEDROOMS PROPOSEDBEDROOMS--?—V'l;TALBEDROOMS�
ONMER a*nWetlpa Illel.1s.lsNn oliraav If.nM1smelbn may muttnea In oN1. -sXnvoaWrt Mmrtelpeme ,Iwitbby
¢ipluWre Celox.I Oetlare Illal l em Ills awns wA I IUMa Wclare Mel l em enlltleE b rective INe Pormtt entl to Ea IM wdk u pmpmeE,l have
oMainM permbsionlrom all Me n6euery par4ea.IntlWlnq any sMemenl ttol0ar or psNea oI nleresl rpeNirp Nb prgecL Tile vmerm opal
repmsenleWe,represents Mn Vle Intpmetlon poWEeE la eaunre eM grants employees of Ns¢cn Lwnry e¢mu to Ne aEow tlercribN pmperly
artl anucWe(e)for miawantl InepaNan, Tlile permlYagAblion Gar mas null8 volE if vqM o,eulMrixeO ansW dron Is nM<onme eE WMM 1Ba
tlaya a Rmn¢tluctim xaA i¢¢uryeMe!M a pnW oI1804ay¢.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTNITY OF THIS
PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
CODNTY CODE 14.08.{ )
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$Ignebre OWNER INusl Ge slonetl the OWNER OeN
DEPARTMENTAL REVIEW I APPROVED DATE DENIED DATE TACSMOTEWCONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH S
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; ) � : $ 110 1 ] .
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