HomeMy WebLinkAboutBLD2024-00098 - BLD CD Environmental Health Review - 1/31/2024 MASON COUNTY PermltNd:RLD9D2+-00096
COMMUNITY DEVELOPMENT RECEIVED
Permit Assistance Center,Building,Planning
JAN 2 3 2024
BUILDING PERMIT APPLICATION 615 W. AWOT ShISOt
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
x NAME: NAME: m
MARMIMNGA ESS: J (1 .i EI MAILING ADDRESS: C
CITY:4hr lLr.. STATE:w&ZIP' CITY: STATE:_2�:
PHONE#I:ila Va 4 �0S' PHONE: CELL: = ;o
PHONE#2: - H EMAIL
EMAIL: At Q t L@I AEG# —/—/— m Z
PRIiNARY CONTACT: GwNBRg. CONTRACTOR❑ OTHER r
NAME-t�1I.Q+C--arro a..sll EMAIL m
44\+A _CITY STATE P
MAILIN DAE35 r?4 Y' z
PHONF.X9��3 A \p CELL
PARCEL INFORMATION D
-�, PARCELNUMBER(12DigitN.Iss) 11A N 7e.' QD \ ZONBJG
LEGALDFSCRIPTION(AN,nnoted) J FEtE DISTRICT
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SITE ADDRESS 61 P l \� aIu CRY VV��
DIItECTIONSTO STTEADDRESS JAN 3 l 1024
IS PROPERTY WT'TIIDI 2003FT FYoFSOFTEIRFOE(S)GRXTER10h HAN14%:: YES[] N0IJ SNOWLOAD:_ysf RECEIVED
SALTWATER❑ LAKE❑ RIVER/CREEK❑ FORDO WETLAND❑ SEASONALRUNO"El STREAM❑
TYPE OF WORK: NFW$I ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTUREJ
IS USE: PRMARYIR SEASONAL[I NUMBER OF BEDROOMS NUMBEROFBATHROOMS
HEATED STRUCTURE? YES NO
Dmc) WORK Y f �' A
EQUARE FOOTAGE:0-psisA
1ST FLOOR__sS.ft. 2ND FLOOR__N ft. 31UD FLOOR_W.ft BASEMEN—K ft
DECK—�, ft. COVEREDDECK .ft. STORAGE vl.fl. OTHER__sq.ft.
GARAGE `I_i[j Awchad0 T>erac'hed CARPORT sq.R AnacFedO DnucAedO
rTLIRED HOME INFORMATION: 'a COPIES OF THE FLOORPi.AN REQUIRED'
MODEL NGTH BEDROOMS BATHS SERIAL NUMBERMENTAL HEALTH: ddWER SOURCE: SEPTICa SEWER❑ / NEW❑ EXISDNGoN STRUCTURE? YES NO❑ V,,,mNh ddsAmsia Wmn Adagpary FormPERIM /tVUNDATION DRAWS PROPoSFD? YES NOQ EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BED ROOMS�— TOTALHIDROOMS
OWNFA IG BEDRO Mel sudn¢slon W lnam�vele Inbimalim meY R-sutlln a sbp wh omerorpemnl rewsetion.4 trimNeGOsm¢Mo(suT Is br
oElaiM1eL pe limissun hom all lM1emneaUsesery Putt�lb IpO arryeeasam10111 bolbeear pe111 Win emslepadnBdhMGm�aThea'metdolrlegN
"n"'ithiah- Igrtes,s Mel Oe inbsmadae pmvidM'u ecunale end glepls employees al""isi CssWa ceto Meshwa tler,-pmpeM
drysw�neln✓:-timvmM1'sdsuspentla]Mepen'od o1p180 days. es null&wld IIvroM or suMaized wns4uctlen anN mmmered Mtlua1N
PROOF OF CONTIN TION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIWTY OF THIS
PE PPLI' / ON OF 180 DAYS OF M OUNTY C"LLODCAUSE E a SaTHE APPLICATION TO BE EXPIRED.(MASON
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Si OWNER M tb etlb GINNER
DEPARTMEWAL W APPROVED DATB DENITD DATE TAGSINOTESICONDTTIONS
BUH.DDIG DEPARTMENT
PLANMNGDEPARTMENT
FIRE MARSHAL
PUBUCHEALTH
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