HomeMy WebLinkAboutBLD2023-01381 - BLD CD Environmental Health Review - 12/8/2023 i0l
MASON COUNTY Permit No: OI Jbi
COMMUNITY DEVELOPMENT
Permit Assistance Center,Building,Planning RECEIV
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRAll INFORMATIONNO
NAME: ,p" NANg: el
MAILING�AAQQDRESS: MAI-A DRES : RECEIVE CITY: loh Ifty__STATE:I,J�Z1P: CCfv:S h STATE:ll ZIR 45S"FY D
PHONE HI: A6y qO 13S1 PHONE: - -(3S3 CELL:
PHONE R2: EMAIL:
EMAIL: L&I REG A El_/_/_ L
PRIMAR ONTALT: OWNER CONTRACTORdei OTHER[]
NAME Ah C EMAIL
MAI LIN DRIBS 0 1 ITY G C A STATE ZIP
PHONE�)4 0-I"H S� CELL Q
PARCEL INFORMATION: Z
PARCEL NUMBER(12 Digit Number) 52.1 _d SS' /0ODD9 ZONING
LEGAL DESCRIPTION(Abl reeietei) FIRE DISTRICT =. rn
SITEADDRESS 1i30l AV'e UIm 17J CITY 0niil Z
DIRECTIONS TO SITE ADDRESS MrfiyNjr fal r 0Z f- Oh AYe//Lim oU y1� D
IS ROJRLT W-M,W,MPTOFSLDPE(S)GRgATERTHANIi°n: YES[] NOd--SF4OWLOAD:_Pef L r
ISPROPERTYWITHINHIOFTOFTHEFOLLOWING: ton,megepyJ:
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF W ORK: NEW e ADDITION❑ ALT�EE��-RA,TI'.I�ON Q❑ REPAIR OTHER ❑ D
USE OF STRUCTURE(xe.wmn,T+mBe.comm,varauB,IDAJ ROo IS USE: PRIMARY❑ SEASONAL❑ NUMBER OF BED MS .t NUMBER OF BATHROOMS_ �P
HEATED STRUCTUREy YES lwid o ❑ YES(Piny)yrel NO ly S
DESCRIBE WORK
SOVARE FOOTAGE:DmPwLI
ISTFLOORl dal 2NDFLOOR eq.ft 3RDFLOOR sq.fl. BASEMENT aq.ft
DECK_eq,ft COVERED DECK—.�sq.ft. STORAGE W.R OTHER NI.ft M
GAEAGE41 1�eq.ft. Aaached� 1'kga had& CARPORT N. AeacMdO Onached❑
MANUFACTURED HOME INFORMATION: ei COPIES OF THE FLOOR PLAN REQUIRED' G
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS HAMS SEIIAL NUMBER
ENVIRONMENTAL HEALTH: I�
SEWAGF/SEWER SOURCE: SEPTIC❑ SEWER / NEW❑ EXISTING
PLIIMBINGINSTRUCTIIRE? YTS❑ NO If,,.avacArompfeled WaterAdequvy Form
PERIMETER/FOUNDATIOND SPROPOSED? YES❑ NOi EXISTINGSQ.FT.
EXISTTNGBWROOMS PROPOSEDBEDROOMS TOTALBEDROOMS
Amen ea,/w.+eeoee ma:ummudon ina2nale m/um,aticn mry roeunFeawp.ww uaar urwm::rewceu.n onncedeign emmwmieq ✓Z.
ppnawre neww.l aeaere:nn i em tlr owner.na i Nnn.,aeaere mm i.m emni.ew receh.mk w,mil em:o eo the ymk ee p,opoaee.i nr.ve
eblJnee pa,miesion from an the raaeean wmes.lnemeing any eneemem eaaer orwNes it interest repardnv tiepa,cay lne weer or legal
tepeeantaeee.represents mtl theFtmmation headed Is excrete and grants entiewees oI Meson county a—to the aeore daMial a p,weM
me evupurets)/or reaex em inewaion. mis pemtivapgiutron Demme:nun a wa if vnA or euwa:ee mnswcuon'ts not mmmerme.aua.tm
am�n mnzendn wn is a�waite.e mr a wader m tw days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 1i.08A2)
SipruWn INOWNER IMit__s,mm IDale
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE I TAGS/NOTES/CONDTUONS
r BUILDMUDEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH 14,1119
P a
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