HomeMy WebLinkAboutBLD2023-01418 - BLD CD Environmental Health Review - 11/22/2023 MASON COUNTY Permit No: RJA202&0/4
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COMMUNITY DEVELOPMENT;-, f,,!` -- z
Permit Assistance Centel Building,Planning
BUILDING PERMIT APPLICATION m Q
PROPERTY OWNER INFORMATION• CONTRACTOR INFORMATION: D Z
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NAME:NyMY 12wAUX MAILING DDR m
MAILING ADDRESS:1N00 vawuyAw NW MAILING ADDRESS: = m
CITY:0aaIXa $TATE:WA ZIPpMs1 CITY: STATE:_ZtP: Z
PHONEAI: PHONE- CELL:
PHONE 82: EMAIL:
EMAIL: L&I REGRYpIND —CF
PRIMARY CONTACT: OWNERO CONTRACTOR annual
NAME EMAIL--W—V-14N"`Ila^X O
MAILINGADDRES510T0 S.Ma6o Lwb.H12 CITY""' SPATE WA glPNmx L
PHONE CELL Pin
PARCEL INFORMATION: L O
PARCEL NUMBER(12 Dill Nlaaba12m1/X2NIH ZONIMG FO rv2
I.BOAL DESCRIPTION(AN,Nviabd)T"oIob #io FIRE DISTRICT
SITEADDRESS.E.W. CITYS "`
DIREXTIONSTOSITE ADDRESE Fdva Wr^NvbE AyW PobETmbM p.W EHenm IXlE.laYgM1vapWblm»YM
ISTNEPROIECIWITIDN300PTOFSLOPFSIGREATERTHAN14'A: YES[3 NOE SNOWLOAD:�.f
ISPROPERTYWITHIN 2B0 FT OFTREFOLLOWPNID lca.ay AW (
SALTWATER❑ LAKE❑ RNER/CREEK❑ PONDQ WETLAND❑ SEASONAL RUNOFF❑ 5'fREAMD
TYPE OF WORK: NEW Q ADDITION Q ALTERATION 0 REPAIR p OTHER R
USE OF STRUCTURE(awuv.Cvotc Ome WMt.E2JflwOYi-
ISUSE PRIMARYB SEASONAL[] NUMBERUFBEDRCO1AS2 NUMBEE.OFBATHROOMS2
HEATED STRUCTURE? YES(wtd.uy Q YES rrvn().ywutl❑ NO❑
DESCRIBE WO WO ua^e
SOUARE FOOTAGE:IA..ya.M
ISTFLOORI2M sAR 2141) O R aq R. 3RDFLOOR_,ft. BASEMENT_p.A.
DECK_p.& COVEREDDECK_p.R STORAGE p.ft. OTHER_,.B.
GARAGE_p_A.ARacAM D De Me D CARPORT p.R. Ava J] Pelad []
MANUFACTURED HOME INFORMATION: V COPIES OF THE FLOOR PLAN REQUIRED'
MAKEbP'WH""- MOIELT^pp3laaF YEAR2N2 LENGTH-
WIDTH2P BFDROOMS2 BAT}LS2 SERIALNUMBER
ENVIRONMENTAL HFALTI:
sewwcrvsewek souacE: sPmtRC B sewER❑ r New 13 mSTA`G D
PLUMBWGMSTRUCTun E? YESB NO[] gya.a cA mWleted Winer Ad"Wa Fomr
PERIMETF FOUNDATION DRAINS PROPOSED? YES❑ NUQ EXISTINGSQ.FT.
EXPSTTNG BEDROOMS PROPOSED BEDROOMS 2 TOTAL BEDROOMS 2
OWNER acknobe0aaa EW auYnlaebn MY�vmaab iMdma4on n,ry reauXin ealop wla valep�pemXl�vw®Iba.MiMNMpemenlalau�tEy
6ON4rtehWw.l GeCNA 1M11 anlleamw enC 1 hNlerCxlare Nel l em eMIIM b re¢Ivd Vb yynnlleM l06 Yer.W\N popuM.l Kn
CbbFNtl penn'¢ticn F«n y XR aaceisary pM'we,ircWin9 enY aaaemmlM1ebe'«Wai..al✓earM rgwelryl N¢pcp=t Mwaw�v IepM
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aya o.e=mawovo..w is aa:ceaeae r«.paM1oa a leo e,ra.
PROOF OF CO MN F WORN ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVPPY OF THIS
PERMIT ON 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 1LO11A2)
B, re EAflM EaaM OWNER)b
DEPARTMENTAL REVIEW APPROVED DATE DENIED RATE TAGSINOTPSICONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH S
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