HomeMy WebLinkAboutBLD2023-01137 - BLD CD Environmental Health Review - 9/26/2023 r P..it No: TJ U.DCA, �0113�
MASON COUNTY rr.. CEIVED
COMMUNITY DEVELOPMENT q
PermItMS stance QnW Building PlanniM,, -CP I COLJ M
BUILDING PERMIT APPLICATION 615 W. NdeT Street Z
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: _ M
NAME:DenaseuHw NAME:sor M 0
MAILING ADDRESS:tllazs EWERSEMYSTSW MAILING ADDRESS: D Z
CITY:ROFrnlx STATE:wA ZIP:sssss CRY: STATE: ZIP:_ t—
PHONE#I:sSafsg4gDT PHONE: CELL: --{ 9
PHONE#1: EMAIL: _ M
EMAIL:--- neadmbeaEppM L&I REG# EXP. / /_ z
PRIMARY CONTACT: OWNEREI CONTRACTOR❑ OTHER❑ D
NAMB e•^x.. e..�.w. EMAIL r
MAILINGADDRESS CITY STATH_ZIP
PHONE CELL
PARCEL INFORMATION: _ SEP
161013
PARCEL NUMBER(I]Digit Naoba)Sleo411�mtD —ZONING '
LEGAL DESCRIPTION(Abbreyia4tl)-UT S OF SP put AF 41101l FN OF NE NE FIREDISTRICF RECEIVED
S TEADDRESSlW SESieror Meeaaeln CITYShenpn
DIRECTIONS TO SITE ADDRESS I..MSL YeY." .as.sa w^Pa
ISTHEPRWECFWITHINM"OFSLOPE(S)GREATERTHANI4%: YESE] NOE SNOWLOAD:S2a(
ISPROPERTYWITHINHIOFTOFTHEFOLLOWING: R:prnd�mxgyryl:
SALTWATERO LAKE❑ RIVERACREEK❑ POND❑ WETLAND❑ SEASONALRUNOFF❑ STREAM[]
TYPE OF WORK: NEW El ADDITION❑ ALTERATION❑ REPAIR❑ OTHER n
USE OF STRUCTURE N-sawc.Gang.Coaonera' OaIe,,
ISUSE: PIUMARY[a SEASONAL❑ NUMBEROFBEDRDOMS4 NUMBEROFBATNROOMSK
HEATEDSTRUCTUMI YESrwm JMXE] YES(WjolAl NO❑
DESCIUBEWORKtae Asmaemsm
SQUARE FOOTAGE:Igwaa:>1
ISTFLOORSTN sq.ft 3ND FLOOIte+M sq.ft 3RDFLOOR as,III, BASEMENT sal
DECK M.ft COVEREDDECK709 K.R. STORAGE sq,A OTHER F4ft
GARAGEIIW K.ft Amassed El Delached❑ CARPORT K.& Aaaahed❑ Dawdled D
MANUFACTURED HOME INFORMATION: e4 COPIES OF THE FLOOR PLAN REG IREDw
MODEL YEAR
BEDROOMS BATHS MISER
ENVIRONMENTAL HEALTH:
SEWAGEISEWER SOURCE: SEPTIC El SEWER❑ I NEwla EXISTING❑
PLUMBINGINSTRUCTURE? YESEJ NO Ifyc.damat coapleled Wow A*,ud,Form
PEUMISTEIUFOUNDATION DRAINS PROPOSED? YES0 NOO EXISTING SQ.FT.
EXISTNGBEDROOMS PROPOSED BEDROOMS!,�� TOTAL BEDROOMS ✓
OWNERa IdoWedMe Me[wGniWm N Mawreh NmmeEon trey mat In a Fop x daN«lamtl rewsYon.Pbvnle0pemera d e«fl is Is,
signature Cei—,a.dere NR I em Me—.,and I NMer Eedare Mar I mn mWeE to reml.tha 1-1 aM Io Eo Me was ea popYM.l hM
attained pa—w ham all Me rwzuary PBRies,ind,dag any easement Wide,.,parties of eraMen repans..this proleh TM wmer or 1,W
represemtiK.repre ma Met Me irRoimBr'ron vrowaee is amuree and Mena mlMryaea 0 Mason County aoddS W Me aWw asOltM pal,erty
e d abutlur ys)for review and in«�.eption. lTls peimNapglluton Wceme6 null8 wld RwnR IXeuMoriiad wnsW Aon o nd mmman¢d xHhF 180
mn dr mm�Fluaon n«kn maP.ndea I«a p«bd«tw d.ya.
PR OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
P APPLICATION OF IN DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
N COUNTY LOGE 14.00A2)
MruMre ofOWNFA IMUMhe alone4 Mtlre OWNER( Deb
M
EVIEW APPROVED DATE DENIED DATE TAGSTIOTES/CONDITIONS
MENTMENT
" ;TOT -
0
9
r 0
♦ \ _ � Y � s a^�3s
n
t 3�g
ao _off s mz ° a
y n N I�cN3 Q�
u >N ♦ 3 p �c<. . a
N�N y w a m y
- e55 5F_ tO I ., �� �y� EVERGREEN
C ll � � ♦�»wLnxG
u g .�.�
PERMIiiING CGNSURING