HomeMy WebLinkAboutBLD2023-00764 - BLD CD Environmental Health Review - 7/6/2023 `R No:'
MASON COUNTY JUL p17� V LD
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COMMUNITY DEYELOP F%r. JUL !911911
Permit Ast abme Cater,9u11dIMPWnnme
BUILDING PERMIT APPLICATION 11 5 W. Alder .Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:C^M'tea NAME:M
MAILING ADDRESS:1100 E SHELTON SPRINGS RD.#18 MAJLMG ADDRESS: m
Crry:shenm STATE:WA ZIP:MES4 CITY: STATE: ZIP: z
PHONE#I:5d2sdoa9e11 PHONE: CELL: C
PHONE#2: EMAIL.
EMAIL:thV9aE]a09mN.mm L81 RED# EXP._/_/_ (Tl O
PRIMARY CONTACT: OWNER CONTRACTOR❑ OTHER Dz
NAME EMAIL NINAMARCHIMCTOYAHOO MIA
MAILING ADDRESS 29808 Was'Road S. CITY e.e.+w.r STATE WA ZIp�
PHONE msNFa,a CELL = m
PARCEL INFORMATTON: z
PARCEL NUMBER(12 Digit Number)2190282AC091 ZONINGS D
LEGAL DESCRIPI'ION(AbMevined)'aria se wa 4s a"" anise"as'a has FIRE DISTRICT r
SUE ADDRESS 149 SE PHgUUPS ROAD S"ELTON WA White CITY
DIRECTIONS TO SITE ADDRESS FROM WA101 TO SE Lynch Re TO SE Phil"Rd.
IS THE PROJECT WITHIN 300 FT OF SLOPFAS)GREATER THAN 14%: YES[] NOS SNOWLCAD:15-Pa!
IS PROPERTY WITHIN NM FTOFTHE FOLLOWING: troaceau fierce s).
SALTWATER❑ LAKE[) RTVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM
TYPE OF WORK: NEWS ADDITION❑ ALTERATION❑ REPAIR❑ OTHER n
USE OF STRUCTURE(aaua,m f rye.C—rwt Atha.ft)RESIDENCE
ISUSE: PRIMARY[]+ SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS_
HEATED STRUCTURE? YES RYaa(r Athyl[]' YES mraf•1 MAt4/❑ NO❑
DESCRIBE WORKNEW ONE STCAY SINGLE FAMILY XOOSE WITH ATTNCNEO GARAGE
SOUARE FOOTAGE:wwasdl
ISTFIOOR1 aq.0, 2NDFLOOR a,0. 3RD FLOOR sq.R BASEMENT sq,B.
DEM N.R. COVERED DECK014 p.R. STORAGE aq,B. OTHER_aq.R.
GARAGELIQ N,R ANached E Detached❑ CARPORT aq.B. Atached❑ Deaachsi
MANUFACTURED HOME INFORMATION: +4 COPIES OFTHE FLOOR PLAN REQUIRED-
MAKE ODEL YEAR LEN
W TH BEDROOMS SERI
ENVIRONMENTAL HEALTH:
SEWAGEISEWER SOURCE: SEPTIC SEWER / NEW EXISTING[I
PLUMBING IN STRUCTURE? YESS NO❑ /fyrs.attach completed Water Ada#aary Farm
PERIMETER/FOUNDATION DRAINS PROPOSED? YESQ NOD EXISTING SQ.FT.
EXISTINGBEDROOMS PROPOSED BEDROOMS 3 TOTAL BEDROOMS
OWNERe6mvehates WI auMn¢tion ofwxuMe"'a-.-may--a Inaskp wk ceder''erne el.tort Ackr egh,ea &suMb by
sgnaWre below eetlare sal Iam1M own and I IunMr declare Net etaeold.to RRrve I'he Pemmt eM to do the vmk as Purposed INre
oGminad pettn6non hour all Ne MclsaBry paNn.lntludinp dray easement Maerw Ipr ias M Intanst regaNly dts p,dect TM waved M9e1
sM swcture(¢I lot mieweM rasped BTh'pemlVepplsedm bemmpe¢nJlBwioEilruAMwsauWrbW wnaWctianab dresmmtencMxiW�M
an P,a aaawmaa wn i.sa.pene�e 1m.paMa d th9 aegis.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE IA08.42)
X 7/6/2023
Signat0N o1 OWNER(Must Its by tlW OWNER) Date
r
ARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGSNOTE&CONDITIONS
DING DEPARTMENT
NNING DEPARTMENT
MARSHAL
LICHEALTH
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