HomeMy WebLinkAboutBLD2024-00082 - BLD CD Environmental Health Review - 1/22/2024 _ . MASON COUNTY Permit NB:jbLjD —OI083
COMMUNITY DEVELOPMEN E I V E D
_. PmMtAmistanceCenioulM7ng,Planning JAN 22 2024 ✓q
BUILDING PERMIT APPLICATION 1p,,NlJ�G,
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: `�CF� <� /
NAME:E WUM.a uc NAME:s "h"^O°^•nr•east"
MA KING ADDRESS:POam2a MAILING ADDRESS:PO a^"M Z
CITY-Alm STATE-WA ZIP:Iffli CTTV:aea•• STATE:WA Z11"Mi
PHONE#1:2nb21MM2a PHONE: CELL:Mad0413"2 �a�I
PHONE#2: EMAIL:ewuunwelIg.rom _ ixa
EMAIL: LRI REG keeexsol EXP._/_/_ m O
PRIMARY CONTACT: OWNERB CONTRAG170i OTHER❑ Z '
NAME^^sessate EMAIL hi aces-esateorrem GJ
MAILING ADDRESS PO Este 76 CITY•4" STATE WA DPMs2" m
PHONE a">easetee CELL Z
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Nnmber)22am5 aa9 ZONINOaF r
LEGALDESC TION(Mbrevia+M) FORE DISTRICT
SITE ADDRESSTED"Attests 31 Few lane CRY3nxb"
DIRECTIONS TO SITE ADDRESS wn."a xb"a-le0 erraoaao,.rn"y.lmtlwa x. -atta Pwnan..APlsoe.+25 wrblam W,
IS THE PROJECT WITHIN 300"OF SLOPi GREATER THAN 12Y.: YES[] NOB SNOWLO.AD:M—If
C PROPF.RTYWTTR 2NnOFTBEFOLLOWWC: hasethaeasesi
SALTWATER❑ LAKE❑ ROVER/CREEK❑ POND❑ WETLAND[] SEASONALRUNOFF❑ STREAM[]
TYPE OF WORK: NEW B ADDITION[]1 ALTERATION[] REPAIR[] OTHER []
USE OF STRUCTURE(Resw sha..Re,com,.a<btaq.Ere.)^••'°""
IS USE: PRIMARYB SEASONAL❑ NUMBER OF BEDROOMS3 NUMBER OF BATHROOM52
MEATEDSTRUCURE? YESIbear Rwy6 YESrRwrPjgQi NO❑
DESCRIBE WORKx"'•3ae
SOUARE FOOTAGE:qa,,,�
ISTFLOOR+22a aq.R 2NDFLOOR_aq.ft. 3RDFLO(M_aq.ft. BASEMENT_sq.ft.
DECK_°—fi. COVEREDDECK W.R. STORAGE ai OTHER_ai
GARAGE_sq.R Atkahei Detached❑ CARPOi Ni ft. A—hM❑ Dewrherl❑
MANUFACTURED HOME INFORMATION: -4 COPIES OF THE FLOOR PLAN REQUIRED-
MAKEPwmxaner MODELSWew3 {'EAR 3aH LENGTH""
WIDi BEDROOMS BATH52 SERW.NUMBER
ENVDtONMENTAL IEALTH:
SEWAGFISEWERSOURCE: SEPTICB SEWER❑ / NEW EXISTING[]
PLUMBINGINSTRUCTURE? YES❑ NO❑ 11')a3.arch cronW,,a W'werAdegrw p FORm
PERtMETER.q'OCINDATION DRAINS PROPOSED? YES❑ NO[] EXISDNGSQ.FT.
EXISTINGBEDROOMS PROPOSEDBEDROOMS TOTALBEDRDOMS
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PROOF OF CO INUATION OF KON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITYOFTHIS
PERMIT APF�CATION OF DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.IMASON
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$10ryryrc MOWNER(Muni beaoeetl b,l OWHERI Data
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGSMOTES/CONDITIONS
jBU�L]NGDEPARTMENTEPARTMENTALTH
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