HomeMy WebLinkAboutBLD2023-00993 - BLD CD Environmental Health Review - 8/24/2023 MASON COUNTY COMMUNITY SERVICES Permit No: IC 2DA$- omq;1
e PERMRASSISTANCE CENTER:
` '.BIIILNING.PLWNING.PUBLIC HEALIH.FRE MMSHAL
(3+ 615 W.PItla 51rea1,5Fe14n,WA 885&
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_ BUILDING PERMIT APPLICATION Alder Str t q�
PROPERTY OWNER INFORMATION: CONTRACTORINFORMATION: GZa?OZ3
NAME: E CiL/}Y.� L6v,PE71-RBCf� RFCE/V
MAILING DRESS: S3 ADDRESS: _ FD
CITY: •N1�/ TATH:y ZIP: CITY: //K L.•rb� STATE: ZIP: ft
PHONEkI: 2S3 273- PHONE:
PHONE O2: EMA6: r L O Om J
EMAIL, O / Crl i L&i REG# EXP.
4i PRA YC NTACT: OWNER❑ CONTXACTOR❑ HB z
NAME S� EMAIL I I
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RV PARCEL INFORMATION: O LLI
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LEGAL DESCRIl'D Ubbmialed) MIYOO/A ��7O�}`/fbQ[/M�S`LF/E�IST�IUCI � _
SITE ADDIlE36 yU E• III FF fOF ( !. 1�2 W CTTY_O _1.7DN
DIRECTIONS TO SITE ADDRESS z
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SLTtWA TYWI'I'BIN% FT EReCREOLD PND (r.Mkdl rnmadrh
SALTWATER❑ LAKE AIVER/CREFK❑- POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK N8R^J!P ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
UMOFSTRUCTURE(xeuxr,rye.raeweaWNd&e )
ISUSE: PRIMARY3. SEASONAL❑d NUMBEROFBEDROOMS S NUMBEROFBATHROOMS Z
S)HEAT STRUCTURE? YES NTMNe AtrmJ P/ NO❑
DESCRIBE WORK
SOUARF FOOTAGE:G -ada�rl
1ST FLO� .� L O`R{L ,.A 2NDFLDOR ' R./L 3RDFLOOR eq.R BASEND]TT�eq.R
DECKy�eq.R COVEREDDKK .R SHORAGE � qR. . OTHER � 'it
GARAGE — agRAMcUd❑ Da1eq CARPORT/ ,iL AtenIad❑ Dmdiei❑
MANUFACTURED HOME INFORMATION: ad1 COPIES OF THE FLOORPLAN REQUIRED•
AKE Nit M • MODEL YEAR LENGTH
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WIDTH BEDROOMS BATHS SERIALNUMBER
ENVIRONMENT 8 EJ TTH:
SEWAGEISEWERSOURCE: SEFT�IcTv SEWER❑ / NEW EXISTNG>(
PLUMBERGERSTRUCTUREa M'g NO {fed,,Meek echo, dWader Adegaary F.
PERP1EfER/POIINDATION DRAINS PROPOSED? Mg NOD E)DSTINGSQ.FT.
EXTSTNGBEDROOMS 0 PROPOSED BEDROOMS TOTAL BEDROOMS
MNFAxdvaMd]e9 MMau.n w-Mlne¢u.,.IrRwmatem,Mult ad e mod x *m,Hr a mmahn maoa4on.PdntxbJpenva of Ndl Is
m,r a me wlw.l and Jare Pal I am Pe wader and I NMer declare that I am wheat to r cave this email aM to Oa the wak as gcgaeM.I Nro
oMaineE lermYabnhan ell Ne--ary panics,InGUPng eny ewement adder.,parties 0 inbnat regmdinB that po)M The wader or wgw
nammedave,repreeemt Pat the tmmnetbn;mad......and tm.a d,eoa al.—,Conye¢ess to the alwre awaited papxry
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date a I mmEUNm aak is mateanded We prlW d IN N}2,
PROOF OF CO TINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTT IT OF THIS
PERMIT AP ATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MABON
COUNTY CODE 14.08.42)
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S n u OWNER fMual be alanedMMa OWNERI
DEPARTMENTAL REVIEW APPROVED I DATE DEN® DATE TAGSINOTEflICONOHIONs
BUILDING DEPARTMENT
PLANNING DEPARTMENT
PIXE MARSHAL
PUBLIC HEALTH Z
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