HomeMy WebLinkAboutBLD2023-01164 - BLD CD Environmental Health Review - 10/3/2023 Oav,sign En clo�lo:)cs58rA425D0.C000-AEISTMI)E5.131A Permit No:& DA 1I w
MASON COUNTY
COMMUNITY DEVELOPMENT RECEIVED
Permit Assistance Center,Buildin 4 Planning SEP 2 7 2023 m
BUILDING PERMIT APPLICATION 615der S"af.
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:DENNIB Psi NAME:Ili Si CConiffloi INC
MAIL GADDRESS:a31015 mssli MAMING ADDRESS:M Boxeaa
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CITY:rm Isi STATE:— ZIP:—n CTiy:ePiPMR STATE:WA ZIP:? E
PHONE#l:ussTBr+eH PHONE:'m°B"'M CELL: 3°°dp1'"� go
PHONE#2: z
EMAB.:pe+Mam•n,Or•noo.omn I.BcI REGp TMscptsxE EXP. 2/1 L Z
PRIMARY CONTACT: OWNER❑ CONTMLTORO OTHER❑
aeavnRlcmx EMAIL
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NAME.oxlern_mvmax Eur STATE"A r�S
MAILING ADDRESS pD eox Mn CITY
PHONE ammr."„ CELL•w•°"'n 007 Q
PARCEL INFORMATION: 37U27
PARCELNUMBERU2DI®tNenn ) arateszmtu ZONINGRR5 18 RECEryED
LEGALDESCRUTION(Abbreviatcd) uxE cusxMRlnriz Ta to FIRE DISTRICT
SITE ADDRESS H N"Fil a CITY H000svoRT
DIRECTIONS TO SITE ADDRESS Wen oO W AItlM St mM pndB ONm*Hwy N,Sol W Welbce BW,ononi WM US101 N,
cart son WA-110 NN Lake CUMmeO RgMR undo W11 to NM lake Cuaamen RQ lell mb GuNmanPotlatM RtlAmnr lakB Rq kR
IS THE PROJECT WITHIN 300ITT OF SL0PE(S)GREATER THAN 1411 YESQ NO O SNOW LOADi
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: P:1d W1Mw,Ppy):
SALTWATER❑ LAKE(] RIVERICREEK❑ POND❑ WETLAND❑ SEASONALRUNOP O STREAM❑
TYPE OF WORK: NEW V ADDITION❑ ALTERATION❑ REPAIR❑ OTHER rl
USE OF STRUCTURE(assool,.�CcmmeaW/9/di,&c)Rr81DExTV1
BUSS: PRIMARYEI SEASONAL❑ NUMBER OF BEDROOMS?NUMBER OF BATHROOMS
HEATED STRUCTURE? YES Mfhli YES ryaN/+]lel#V❑ NO❑
DESCRIBE WORK INsrO1L NEW Mx fort RealbrNtuE use
SQUARE FOOTAGE:(,,Ss4
ISTFLOORtTns aq.R. 2NDFL00R_rq.R. 3"FLOOR_q�R BABEMEM'_eq.ft
DPCK_eq.R. COVEREDDECK_eq.R. STOBAGE MI.R. OTHER__q.R
GARAGE_rq.ft A#nuhedo Dano,hol CARPORT rq.R. A#i[] Demrbd❑
MANUFACTURED HOME INFORMATION: m0 COPIES OF THE FLOOR PLAN REQUIRED•
MAKE%EHOME M00ELPINEHURBT2501 YEAR_LENGTH< V
WIDTH as of BEDRCOMM2 RAMS SERIALN[AdM Ia
ENVIRONMENTAL HEALTH:
SEWAGWSEWER SOURCE: SEPTIC 2+ SRWBR❑ I NEW❑ "ISTING0
PLOMBING IN STRUCTURE? YES EI NO❑ If, sno I cdo ji Wwa Ado oI Fenx
PERIMETERIPOUNDATION DRAINS PROPOSED? YES❑ NOB EXISTING SQ.".B
EXISTING BEDROOMS 0 PROPOSED BEDROOMS° TOTAL BEDROOMS?
owxER.Unowieep.s ual eunm§•lpn WYuaum•mrolmNm mrv,esun In aslcq vvM1 oN«or permllrewl'a1M.ACX IS Shoat,I Sof. M
•ylalure nebw. es J•re mal em Ind arm•r.M Nnner eeckrt u•1 em•nvnM m receive mle ce.^n ene W au ena wan es a�s•e. Ilex•
oae'.m p«missson M1om•n Ind necessary veNeS.Ymweing.nY•99emem Mleer w pauses of Iinsei re9aNing this p9ed Tine am9,or I•pM
repn••nhise,repr••eMs Ina:hi snlormellon pov✓J•l h acWmle aN gram•employees of Meson Cooney xcess to Ne earns 0esys4•e PWBM
end�X mnl,for m w onsi,o:penem im a peme m+0 Eey¢.Na•nmes null a vole n wan m aumor'lzee ron•wcoon®rA commacea vntM too
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PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF 180 DAYS OF M COUNTY EWILL CAUSE T HE APPLICATION TO BE EXPIRED.(MASON
9/20/2@3
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- '�IEOB0rt00TOWNER fM M Intl bvtha OWNERI
DEPARTMENTAL REVIEW APPROVED DATE DENH:D DATE TAGSIN0TESIC0NDRI0N6
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL r 1 C
PUBLIC HEALTH Z 1, )
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