HomeMy WebLinkAboutBLD2023-00837 - BLD CD Environmental Health Review - 7/26/2023 MASON COUNTY COMMUNITY SERVICES Permit No: t• ILL '*'DA7J � DVCJ/x
PERMITASSISTANCECENTER:
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RECEIVED
615 W.tWar Shaer Stuart.WA W W
PMrre SMM:(360)CLB6IG ex!.g5L Fan:(360p1I-TiB6 rre 2ra... JUL 2ULJ —
Sit(%0)273 46I•Plwna FMe'1360)162-3268 LSw 9 LUL
BUILDING PERMIT APP ICA N tree
PROPERTY OWNER INFORMATION: CONT CTOIN INFORMATION:
NAME:
MaN FNrary 13l NAME: IVED as
MARANGADDRESS' Ne Tp.rtaL.aewm Mal ADDRESS: z
CITY: + STATE:wA ZIP:eesze CITY: STATE: ZIP:
PHOPIE RI: PHONE: CELL:
PHONE 42: EMAIL:
EMAIL:moratixraeydN.mn L&I REG# EXP._I M O
PRIMARY CONTACT: OWNER[I CONTRACTOR[I OTHER[a D Z
Fill-sar--sramre-sugar EMAIL Ayw•r�Nrbma •�
NUUMNGADDRESS Mm—saaroass CITY R.nm STATE wA ZIPM'am
PHONE CELL mastm S M
z
PARCEL INFORMATION: �
PARCEL NUMBER(12 Digit NlNtbN) +2a064!ls101 ZONINGRuaIRrNeMNSAaa(RRSI
LEGALDESC TION(Abbreyiase0) v++BeauL.z4x 1rzm1oc D.I.x FIREDISTRICT r
SITE ADD NE Laaa Rd w.0 CITY aenw
DIRECTIONS TO SITE ADDRESS
MS EPROnE WITHMO nOFSLOPE(S)GREATERTHANI4%: YES[] NOD SNOWLOAD:zs paf
ISPROPERTYWITHIN20OFTOFTHEFOLLOWING: R:�mHarupai
SALTWATER❑ LAKE 0+ RIVER/CREEK D POND❑ W EFLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK NEW 0. ADDITION❑ ALTERATION❑ REPAIR❑ OTHER I]
USE OF STRUCTURE(p¢aWmn.CmaP,Comutla&dg,Pic/sinBh F.mly Rwdarr.
ISUSE: PRIMARYO SEASONAL❑ NUMBER OF BEDROOMS 2 NUMBER OF BATHROOMS
HEATED STRUCTURE' YES txanargua ❑ YES(PonlaJm`1uho D+ NO
DESCRIBE WORK New aryhalcry SFR em mall man.arras mars,awmea.her pros
SQUARE FOOTAGE:o trawl
1ST FLOOR 85 I aq.ft 2ND FLOOR v r_!4 xq.R. 3RD FLOOR sq.IF BASEMENT_sq.R
DECK sq.& COVERED DECKaul4 sq.ft STORAGE sq.ft OTHER' _,.ft
GARAGE>eNz sq.IF Aua¢hed 0 Dalai[] CARPORT sq.ft Attached❑ Detrained
MANUFACTURED HOME INFORMATION: •4 COPIES OF THE FLOOR PLAN REQUIRED•
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGEISEWER SOURCE: SEPTIC Oi SEWER NEW Oi EXIS➢NG❑
PLUMBING IN STRUCTURE' PESO NO D Ifyea,arl ronapletrd Wmar Adeal Form
PERIMEfERT0UNDATION DRAMS PROPOSED' YES D+ NOD EXISTING SQ.IT,
EXISTINGBEDROOMS 0 PR0FOSEDBEDROOMS2--Z TOTAL BEDROOMS 1--V
Cat x}nasedges met su rmissan otlnevmmmmtonnslm may reaut in a sop amr,comar or perm.rew2aon.AcknoMetlsemeMot wM ie Ey
tonal asow.I oaaam Ntl I am me om2r ens I ful declare met l am entral to nimeare this permit and to do me wak as Parl.I mom
MtBNesp—issionkom "'anessam parties InGWing any easement.older or padies MInt¢res regaNins IM1Is prgeG. ➢aomeror legal
Rpeaenua W,no-sams that Ce minimal IXohded Is awash aw palls employees of Mason Courts access to Ne asoee descnited peeper,
end sOWureh)brreNex aM inspeann. Tlas permustoammn Mmmes null B o id dxoM m aumori al mrsWcmn IW
drys mRmnatlu don xctk b aueperAed Iwa period N 160 Mys.
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 14.0g.42)
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Sqn.tbre OWNER(MudWsionWWMeOWNER) Dal
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE =TAG�OlS
771f{ BUILDING DEPARTMENT
PLANNING DEPARTMENT
J FIRE MARSHAL
{ PUBLIC HEALTH S
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