HomeMy WebLinkAboutBLD2024-00470 - BLD CD Environmental Health Review - 4/12/2024 Permit ND: 1"I Lo24 L �
MASON COUNTY F E C E I V
COMMUNITY DEVELOPMENT Perm MAR 14 24 [^y
itA istance Center.Euildir+g,Planning MAR
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BUILDING PERMIT APPLICATION W. A r S C P.?
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: F 1p1/
NANff:M.'KL rt KA7HY RosL7.F' NAME:/n.'/if g�tEYN
MAB.AIG ADDRESS: 30/ gCvoTL� MAILING ADDRESS: Ciol E qb rV
CTTY:S/CLTw.v STATE:aL ZIP:98 CITY: sltLT,v STATE: Zff:9KPy
PHONEMI: 3Lo - Y9o_ DTPC, PH0NE3fe•Yxu•T3L9 CEId.:3Lo-Yfn-aT0 =_rA
PH0NEH2:JLa - y29- T.a66 EMAIL: N
EMAIL: Kf_ 4ua,L72V a YcTc L&I REGNAysC7Cf03LL2 EXP.3 /AF/2E D
PRIMARY CONTACT: OWNER[]- CONTRACTORB' (37HMD
NAME /N EMAIL A<C oan
MAILINGADDRESS 6.h/ L AC 7A ILL CITYS L w STATE w 21p 9sfly = III
PHONE 31t- - VzC-T941 CELL .Tla -YFC- 0120 Z
PARCEL INFORMATION: D
PARCELNUMBER(12 Digit Numb.) A2D/P-•/3— 00020 ZONING (-
LEGAL DESCRD'IWN(Abbr iated) FIREDISTRICT S
SUEADDRESS GI GI f 146.w TL RO CITY .rbLL7.�. L/NSli.
DIXECIONS TO STTEADDRESS /y ✓.,.ram e... Ar�AT wr �✓ .. L,.T e_ A��-J ILA
ISTMPROJECT\YUT@1300FTOFSLOPE(s)GAEATERTRANI4X: YESD NOB'SNOWLOAD:_par
ISPROPERTYWTTHIN200FTOFTHEFOLLOWING: KhwLdfrxw.ypyl:
SALTWATER❑ LAKE❑ RIVER/C D POND❑ WE [] SEASONALRUNOFF❑ STREAM❑
TYPE OF WORK: NEW❑ ADDITION❑ ALTERATION❑ REPAIR❑ OTIIDi (l
USE OF STRUCNIRE(xuu.xa meexe ex.w.Rwagenl Lxx"d cz
IS USE: PRIMARY U,SEASONAL❑ NUMBFROFBEDROOMS 2 NUMBEROFBATHROOMS /
HEATED STRUCLIRE? YES fW IBW[a]' YES ranTa]oJxrexl0 NO❑
DESCRIBEWORK RL A N N•vr&
SOUARE FOOTAGE:ffey.wel
ISTFLOOR�_6_ .R. 2NDFLOOR aq.R 3RDFL00R vi.ft BASEMENT N.ft
DECKLLO aq.R. COVERFDDECK_sq.B. STORAGE 'IL OTHER_aq.A
GARAGE_12_C CARPORT ml.ft Am DTMa &D
•/COPIES OF TIRE FLOORPLAN REQUIRED-
MODEL LENGTH
TR BIDROOMS BATHS SERWI.NUMBER
ENVIRONMENTAL IHEALTEI�
SEWAGESEWER SOURCE: SEPTIC SEWER❑ 1 NEW EXISTING2]
PLUMBING IN$TROGTURE? VEER' NOD Tj0'er,anauhmmpletr Waerfdegoary Form
PERILIETER/FOUNDATION DRAINS PROPOSED? YES❑ NOBI EXISINGSQ.PT. Soy
EXLSTWGBEDROOMS Z PROPOSEDBFORGOMS ], TOTALBEDROOMS 2
OWNIReckreMeags mtt au4mlaspn or inecure+e lMorm&im may rewPln earW wxk xtleror pemrM rewurM.AUagMaapannnr olslMrY Ey
agrewm below.(exMre me+l am meawnx ens I mnnx daolare mm I am enNMa m reserve mia cermn arm m ao me wom ea pro�aea.l nae
Mnlretl pennisson ham ell Ne rceeaeery peNee,Inclutin0 enyeesemenl Mkx or peNx d Inrxvt repeNlry INs prGecL Tha owner w legl
repeeenmtNe,rapaseNs leetllie infxmelbn prwtl�ie eccuMe ana gems rnployses of Mam Ceunry ccwm me Ywue axctlCeE popsrry
ens stnslure(a)ror reWew eM NpecEort ThkpermNeppAntim Eecwnx w116 wkl1work ar eurMrizea wnawNon la rutwmmmlcea wNbh11B0
aya m xcmawmmn wdr Iaaamxmee rare cedoa a+m saw.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTMTY OF THIS
PERMIT APPLICATION OF IN DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
/ � , COUNTY CODE 14.08.42)
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X 71w/4 ( .3//0/302y
Signswe of OWNER(Must W stoned by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TACS/NOTESICONDTOONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC BEALTH I
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