HomeMy WebLinkAboutBLD2024-00005 - BLD CD Environmental Health Review - 2/15/2024 Permit No:I
MASON COUNTY
COMMUNITY DEVELOPMENT FEB 01 2024
Pomltyksirt not CerRer,Building Planning
BUILDING PERMIT APPLICATION 615 W. Alder treet k ^
PROPERTY OWNER INFORMATION CONTRACTORINFOR_MATION 63
NAME:Omwtl AnOmyRm CI ?j
MAI.IIGADDRESS:POOp NAME (P ar
MAI.ERO ADDRESS
CITY:BNbIr STATE:WA Z�:gBsm CITY: STATE: _ZIP: O
PHONE#1:3Ba7s PHONE: CELL:
PHGNE#I:3meMM, MAIL
EMAIL:aomlmrmNe.mm L En REG#sAn.WT
EXP. 12/9 24
PRDARYCONTACT• owFNRR❑ coNTaAcroap oT1cID --- C
NAME a.auuw Z 17'[) EMAIL r'NOeanmla .ma
MAIWNCADORE551xv MamRmamRn CITY 9aM STATE"'�UP—
PHONE CELL ams'amm m O
PARCEL INFORMATION: D
PARCELNUMBER(131)igit Nombm)n11LDSOp10 yGNINGRRg q �
I.EGALDFSORI ON(Abbreviated)TRAOi3URJEYVOL3MOBPTNMMW FIREDLSCRICI3 m
SffEADDRESsaw E.Trwiw Re CITYaaFseMs' Z
D�ECIK)NS TO SITE ADDRES$ rmararxnenmwsmeam,rM Ry4ww.wxnemm.w,u.,p.rrem®syirrernryp
MTRRPROJECTWR 3MHTOFSLO PR(3)GRKATFB TBAN I/%: YES[] NO(]i KNOW IAAO: N
IB PROPHRTY WIYHIN 300 FT OFTIIE FOLLOWING: rtA.caeuwr,ppyl:
SALTWATER[] LAKE[] RIVER'CREEIC❑ POND❑ WETLAND[] SEASONALRUNOFF❑ STREAM
TYPE OF WORK NEW 21 ADDITION❑ ALTERATION❑ REPAIR Q oTHER rL
USE OF STRUCTURE Inna.,�pay.,C.,m,.al,Isugze./Rwtlama
ISUSE: PRLMARYQ SEASONAL❑ NUMBER OF BEDROOMS a NUMBEROFBATHRGOMS3
HEATED STRUCTURE? YES ImM BkW❑ YES ryanlrlgrAW O ME—] —
1 DESCRIBE WOAKNM'Oammrdimwssimb Nmly Name
SQUARE FOOTAGE-
ISTFLOORIOaa aq.ft. 1NDFLOORwB q.& 3RDFLOOR_eq.R BASEMENT—_ _aq.R
DEC43j eq.R COVEREDDECICI _aq.R STORAGE R.IL OTHER_p.R
GARAGEIM aq.R AsooWEI Der W[3 CARPORT sq.R ARwhad[j Datsha[]
MANUFACTURED HOME INFORMATION: e4 COPIES OF THE FLOOR PLAN REQUIRED-
MAKE MODEL YEAR LENGTH
WD)TH BEDROOMS - BATHS SERLU.NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWFR SOURCE: SEFITC o+ SEWER❑ / NEW Qi EXISTING
M:uma NGINSTRUCrURET YESR] NO[] �)wF mahmmpbmd WRmrAbquary Farm
PERNBTER/FGUNDATR)N DRAINS PROPOEEDR ME NO EXISTINGSQ.FT.�
EXISTING BEDROOMS PROPOSED BEDROOMS 3 J TOTAL BEDR00M33
OWMER admoNmdms tMtsumnimbn otimccumh htormoon my msm in a bop work omm or vrmR m acamm MJmo Wrosm mzxM1bb
sipnaNre blw. dedan tM1atl pn mawneraMlNMVEttlara tlurlam pNYW rommiw Nk yrtne endm MtMxOMeagoparl.Ih.
Mtain1�n� W a 4 ,rreor lroma lIa mworm pynbwdnclu dnagc
and elore,,swendhem , Tiert aawnyn e.MfleeMrMgemMr M1anaoukilegr adbrdW VNaxemdM d oirreee mreC9O re�gaN=Mneg tl NbM gnp l¢Mbnm. TharNewcmnriwMWrpo rp
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PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF )DOS OF MORE VJILLCAUSE THE APPLICATIONATION TO BE BE EXPIRED.(MASON
COUNTY tA0E d4.geAR)
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DEPARTMENTAL RENUIV APPROVED DATE DENIED DATE TACg/NOTESICONOMONS
BUILDING DEPARTMENT
' PLANNA`ODEPARTMENT
FIREMARS}AL
PUBuCHEALTH
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