HomeMy WebLinkAboutBLD2023-01211 - BLD CD Environmental Health Review - 10/31/2023 �.. . Permit Nu:J t-170qV a7j"o a 1
MASON COUNTY ^ ECEIVED
COMMUNITY DEVELOPMElJ�
Permit immce Center,BMNIr,Flaeelry OCT —9 2023
BUILDING PERMIT APPLICATION OCT
12043
PROPERTYOWNERINFORMATiON: CONTRA RMATTON: �NAME:JENMFE!Irt CBEDRANDMANSQIREN NAME:BIACK HIIIS BAILERS RECf/VfD
MAILTNO ADDRESS:195g(NtHRA M SW MAILWO ADDRESS:I3I9114TH AVE SW
C11'1:TLI1wATFA STATE:WA 21P.IMS12 (,'ITZ':I wpM STATE-.WA y@:Bast2
PHONE81:5aeuomm PHONE:3m35oalwl CELL:-763-at
PRONE W2: EMAIL:— +
EMAIL:wnAmIlsMOu real— L&I REG gelnaaeusOw ERP.4 /2--/ff
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PRIMARYCONTACT: OWNERp cofITRacroRp OTHSRp
NAME m EMAIL bm 91111Reei
PHONE
aTY ^*� IVTAL
PXONH N'®� CELL
PARCEL INFORMATION: HEALTH
PARCELNUMBER(12M&NWBBer) 42 TB80W4 ZONING
LEGAL DESCR ON(Abbavietei) FIREDHDAICI
SUEADDRESS WWMEADOWSB CITYS ma .585M
DMCDOMTOSITEADDRESS wMmus tot,IM Mw DayMAupalRwe.bMB.t nua em eammwoyYn Trent Oha,
tm93 niea,hm bllm NaY m W OyMI Tnib IX,Em egMm W MCWxa P1n,sIY Ym NamliL
LATHEPROIECTWI'TIIIN3NF1'OFSWM(S)GREATER' 11Y.: YES[] NOE] SNOWLOAD:_yFT
IS PROPERTY WITHIN 3BB FT OF THE FOLLOWING: ICE. ..,,P:
SALTWATER[] LAKE❑ RIVER/CREEIc❑ POND❑ WETLANDp SHASONALRUNOFF❑ STREAM[]
TYPE OF WORK: NEW(a ADDITION❑ ALTERATION p REPAIR p OTHER p
USE OF STRUCTURE(R® Cs+aAu..wwexg.zo SINDLE FAMILY PEm1EI1GE
ISUSE: PRDAARYQ SEASONALp NUMBEROFBEDROOMS B NUMBEROFBATHROOMS2.5
HEATEDSTRUCTURE? YES(NEdn BWy0 YESMr ,iefBWVp NO[]
DESCRIBE WORE NEW STICK FRMS)81Ni FAMILY RESIDEME
SOUARE FOOTAGE: ,re re
1ST FLOOR 2116 p.R 2NDFLOOR p.R 3RDFLOOR sq.& BASEMEN sq.R
DECK p.R COVEREDDECE 550 p.& STORAGE-,.R OTHER p.R
GARAGE tote p.R 1 13 Detarii CARPORT p.ft. Artachmi[] Demhd❑
MANUFACTURED ROME TNFORMATION: eC COPIES OF THE FLOOR PLAN RRQUIRRDn
MARE MODEL YEAR LENGTH
WIDTH BEDROOMS RATES SERIALNUMBER
ENVEtONNIOTALEEALM,
SEWAGEISEWER SOURCE: sEPTicp SEWER❑ / NEW El EMSTMG❑
PLUMBING W STRUCTURE? YES 8 NO❑ ifyas afwA mmplesed Wm®Adegeary Foml
PFRB.D.TER/FOUNDADON DRAINS PROPOSED? YES NOD/ EDSTING%FT.
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=STINGBEDROOMS PROPOSEDBEDROOMS 4 TOTALBEDROOMS e
OWXER ecknwleOp�MMnBnLnbn of Fmm�eln l�Ranmem may maJlNealm wkaLLivHanYlle �IIm NMnwAeOaemnM rrtsutlikpy
n'gne4re Mvn.l Ev.Yn tlml l em Me omr..en01 hiMal Entlarn Mat I am nMNee b reveire Nu yamM ak b d W nwk an pogcN.I M1m
oWintl Pommim Mm eltln nnmsusry paNes,irWein9 am'BbameM BnLYfe PoeY6 MMWMI ieBan9n8 Min Ixgxl Rz oxreia�legal
,p�eaernsu�+.npwam Mama inrommion am�ene Y a�nn ane arema nmgn>,e.arme.m canny eTnnm me emre aeamLee PmPoro
eb smrn.elgta reJen um lnaPaalon TN:pemiluelcllPonon Becomes neu a vae n raix vnuMonzea conneucnon Is M mmme�mtl xinen tao
a.W w rcFmewmm xwl Y ewlMmmrme Deem a taB aeW.
PROOF OF CONTINUATION OF WORN 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
COUTYN CODE 1/.m.42)
SIBneW ER(MYBt Be slMnetl YY the OWNER)
DEPARTMENTAL REVIEW APPROVED I DATE DENIED DATE TAG"OTESICONDITIONS
BUILDINGDEPARTMENT
PLANNING DEPARTMEN
FIRE MARSHAL
PUBLICHEALTH f
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