HomeMy WebLinkAboutBLD2023-01243 - BLD CD Environmental Health Review - 10/13/2023 MASON COUNTY Permit NO: (P45
COMMUNITY DEVELOPMENT RECEIVED rn
Permit Assistance Center,Building,Planning OCT 13 23 Z
BUILDING PERMIT APPLICATION <
61 IN Aid r Street ;a
PROPERTY OWNER INFORMATION: CONTRRA1lC'T,O'R INFORMATION: wr Z NAME: LMft
t N. NAME:L�(�p 9!MATNG DRESS: GAD17RFS5CTTY ZIP: CITY: STATE: I.-q-ZIN,
PHONE#L 0. PHONE: CELL: = Z PHONfi#Z: EMAI.: w rti,
EMAIi.. L&T REG#
PRIA I} OWNLI�,O' CONTRACTOR OTHER[] r
MIL h EMA1�iwIlall Ill��NYC
PHONE pTD N CITT JQ_+'SfATE ZIP_
PHONE '�.iI�J.I / _ +C \ ALL
PARCEL INFORMATION:
PARCELNUMBER(12Di®txumber) 3 I TONING DLi
DESCRIPTION(AbbrevieteE) FIRE DISTRICT'SITEADDRESS Z CITY OCT 1D DNS TO SITE ADDRESS �. RECEI
IS=PRO]ECTWITHDN30#FTOFSLOP S)GREATERTHANI<%: YES(] NO SNOW LOAD:�psl
ISPROPERTYWTIIIDMFTOFTREFOLLOWING: ry'pectmlrkvgapry).
SALTWATERQ LAKE[] RIVER/CREWD POND❑ WETLAND[] SEASONALRUNOFF❑ STREAMD
TYPE OF WORK: NEW Fy ADDITION Q ALTERATION❑ REPABt❑ OTHER ri
USEOFS'IRUCTURE(r ,, J�,�Ne� �.B*,,.) yt11& A- cy--
MUSE: PRIAARY,ff SEASONAL[] NUMBEROFBEDROOMS_ ,3 _NOmErROFBATRROOMS
HEATED STRUCTURE? YES(11ssa r{)Z YES P 1HBbg1 NO 1
DESCRIBEWORKNOA VI A) (A)Y\S1' Af�'I J✓Y MDN\ll IA^P A � 'f—
SQUARE FOOTAGE:p,oP q
IST FLOORIat0B q R 3NO FLOOR q.R 3RD FLOOR q.ft BASEmENl q.k
DECK q.M COYEREDDECK q.ft STORAGE q.ft OTHER K&
GARAGE q.R. Attached❑ DemrnmCl CARPORT q.R AlmchedO Dwww E)
MANUFAC
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,URED HOME INFORMATION:���� �� ��•a C� OPIES OFF THE FLOOR PLAN RE tJMDa
MAKE k MODEL MhA DLU at_YEARJLJLL LENGTH ba
WmTH BATRS�SERTAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGEJSE SOURCE: SEPTIC SHIVER[] / NEW[] EXISTING❑
PLUMBING IN STRUCTURE? YESe NO❑ I9^;ealc plamd Winer Ada,u Form
PERIMETERI'OUNDATION DRAINS PROPOSED? YES❑ NOA EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 3 T'GTAL BEDROOMS
MINER aMrwiAMpae Nei wEmbebn IN Yuovmle YXanurim mry rawll in a stop xak eker d penM rerveatlan.Atla W etlremml M autll b ty
eNnqure EeWw.l Eptlare Nn em Me omarenE MIM aeGert NBI em entltlM to rephe Nie rymX eM to OatllexorkaB pgosM.l haw
,stained nermisson hwn all IM—'r,Wrxm,Inaumae any ea—nvt Wider ar waiaamimmasl mgannow Nb wna- XXa wnn or mwl
moleeemetiw.repro:ema xretme imo,netion rrowaoa a era.nlc and arenb emaloyo.e m weon co,my.n-.esmnearow a.aaie.a arop.ry
endsp-Rconnsllet In eMm,aad.TasprnnnrepglGtlonmmmea nWawia xvuh or euNontta Wn&NtlMread 6amerMa MNm IW
inn arX wnsr,mo,wax is wepenaed m.wand also
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTMTY OF THIS
PERMIT APPLICATION OF IN DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.H.6])
n n EN
DEPA APPROVED DATE DENRr,D DATE TAGSMOT'PSA,'ONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIREMARSHAL
PUBUCHEALTH t �.
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