HomeMy WebLinkAboutBLD2023-01131 - BLD CD Environmental Health Review - 9/20/2023 MASON COUNTY PeTD,ItNo:b4A0M-0l13
COMMUNITY DEVELOPMENt>E C E I V E o 0!
Permit Assistance Center,Building,Planning La >
BUILDING PERMIT APPLICATION SEP 20 2023 ryu W
PROPERTY OWNER INFORMATION: CONTRACTORIPFORMAN1,SW Alder e t N
NAME:�Sweooea NAME:S*nfa
MAILING ADDRES&MOS ft—o fos S.E. MAILING ADDRESS:
CITY:A ,,, STATRWA 2IP:00002 COY: STATE: ZIP: Z
PHONE#1:433A^^a333 PHONE: CELL:
PHONE#2:a53-74M210 EMAIL:
EMAI,:�—Ml.edm L&I REG# EXP.
EMAIL
PRIMARY CONTACT: OWNERB M CO]f OR❑ TH OER❑ m Z
MAILINGADDRESS CITY STATEZIP
PHONE CELL.a�.ra. T
PARCEL INFORMATION: i z
PARCEL NUMBER(12 Digit Number)3210 00015 ZONINGM-5
LEGAL DESCRIPTION(Abb Ufdif AMa k"Y 610MIS FIRE DISTRICfa D
Siff ADDR633t2t E M.nme f C=Uwn r
DIRECTIONS TO SITE ADDRESS fiWOW b 14RrrY Nmw MesAMM"M do Vm MapMb Sum OMOm OYtlAery
WS PROJECPWITWNMn OFSLOPE(S)GREATERTHANI4%: YES[] NOB SNOWIAAD:M Psr
MPROPERTYWITT MOFTOFT MLLOWROG: K'a�NfMA.yryJ:
SALTWATER❑ LAKE[] RP/EILCREEK D POND O WETLAND D SEASONAI.RUNOFF D STREAM O
TYPE OF WORK: NEW B ADDITION D ALTEMTION❑ REPAIR❑ OTHER D
USE OF STRUCTURE(R.ae.m.�.cmre�wAltEmJReaHe^re
ISUSE: PRIMARYB SEASONAL[] NUMBEROFBMROOMS2 NU,,SROFBATHROOMS2
HEATED STRUCTURE? YES(05•I w w B YES(PWil4&v D NOD
DESCRBE WORKw^'ewm'mn
SOUARE FOOTAGE:(v, )
1STFLOOR142 q.& 1NDELOOR_N.ft. 3RDFLOOR q.R BASEMENT R.A.
DECE q.R COVERED DECK q.R STOMTIE q.R OMER q.A
GARAGE" q.ft. Arb`ANB DetaeSN[] CARPORT q.ft. Ao AND Dm.W[I
MANUFACTURED HOME INFORMATION: •e COPIES OF THE FLOOR PLAN REQUIRED'
MAKE MODEL YEAR L�iTDf
BEDROOMS MTHS SERW.NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTICB SEWERD J NSWp MSTTNG❑
PLUMBING IN STRUCTURE? YESB NO❑ UPer,mraoA ooW1.1N Wure.Ad nru Form
PERRIETERhOUNDATIONTTDRAINS PROPOSED? YES B �1 NOD ERISfING SQ.FT.
EXISTINGBEDROOMS !.J PROPOSED BEDROOMS 2. TMALBEDROOMs?,
.WRerbaMtl - aiYmmWkn Niamrn.lnbmnEon"mutt In eabp—Wx or 1-1 re mJlkn.4dnvMea oo-ofw 4q
alpMure ltl IdedereuWInm.tuner.INNnrawim HalTen anWNa tosuite tivr puma..b m.xvk esp .I h.
.t,.n.a p.miw.i.l—..nre Mce ,Caa.o.-mtluang eryenemnl ndam.rp„4e.MI.Mmf reawane uls wq.e.Ttt.O/.'ne orb
renr—Ito w,oa,— n Mel the ofonnifan p—da s—rue YM Peae empbyw.e of MWnn C nn evaSsm M.e tleoiM P4
.naebuC,mrstfaooW andlnscon. mbpxmNeppl®TonLeuvrm n.n6void anwk or xNMnzeo cwvEu 1ai'YMoomm.rtw]MMIn teo
say.0r a�rew�n.n wa..nap..ed m.p.ma a t ea a.ys.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTMW OF THIS
PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
/n
COUNTY CODE 14ABA2)
R &41v- 'f 09-13-2023
Sgmbre of GWNER(MUM W SIenN M nM OWNERI Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGSTNOTESICONDIDCNS
BUIDING DFPARTABM
PLANNING DEPARTMENT
FIRE MARSHAL
PUELIC HEALTH
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