HomeMy WebLinkAboutCOM2022-00085 - COM CD Environmental Health Review - 9/19/2022 MASON COUNTY COMMUNITY SERVICES Permit No:
PERMIT ASSISTANCE CENTER: C i s-
•BUILDIA411. MNING•PUBLIC HEAIiN•FlflEMAfl51UL II.. C
615 W.NOer SbM,51W10ry WA!)i
Pltnnn Snellon:(.3�)121-961p BN.352.FflY:(360rN1]-]]99 Paq'1a �" J a 2022
Barran:[3m/zTsyaeT•vlmre EPre:(Bm)aers� CP
BUILDING PERMIT APPLICATION 615 W. Aide Street
PROPERTY OWNER INFORMATION, CONTRACTOR INFORMATION:
NAME 2r lw P. 4, NAME Sg L I=
MAI LING ADDRESS: MAILING ADDRESS:
CITY:1521(4,a SPATE ZIP.ldT'L CITY: SrATE_ZIP.
PHONEPI: 26^, lr/e d$« PHONE CEII.
PHONE -9 217 EMAIL: —�
EMAIL L&I REG t EXP.Jam_ Q
PRIMARY CONTACT: owNExQL coN1'RAC'1'ORp OTHER[] Z
NAME Al+..✓. EMAIL w =
NAILINGADDMS CITY STATE_ZIP_
PHONE CELL G
PARCEL INFORMATION, Z Q
PARCECNUMBER(12agit Namber)(2321— t/2-6h02A WNINGt l✓RL O W
LEGALDFSCRIPf10N(Abbreviatd) P�12 a� $IA a17-2/ F sIREDISTRICT mez =
SITEADDRESS L 5rArC Cr CITY &;F`FAet<
DIRECTIONSTOSRF�ADDRESS AV Z
�99 jfet;�/itiona h ..F /DFc 2i J Ss a W
LSTHBPR07ECT4TRBVM"OFSIAPE(S)GREATERTHAN14%r YES[] NOO SNOWLOAD:/sf
W PROPERTY WITHIN 2B6 FT OF THE FOLLOWING: (aaeausMappyl:
SALTWATERD- LAKE[] RIVERIC [] POND❑ WEI'IAND❑ SEASONALRUNOFF❑ STAEAMD
TYPE OF WORK: NEW p' ADDITION❑ ALTERATION p REPAIR D OTHER p
USE OF STRUCNRE(Rorai ca'.eemmwrnal&4.ae) (r d..,.,.,Uc.
ISUSE PRIMARYfd SEASONAL[] NUMBEROFBEDROOMS NUMBEROFBATRRODMS_
HEATEDSIRUCIURE? YFS(tybeh N4)❑ YES IPwftl 141ae1❑ NOS' P--rir4'cs/t
DESCRIES WORK /ICe•e l�. r�/tie Ai..+
SQUARE FOOTAGE,
FOOTAGE:(,dri
1STFL001£p�Op_sq.Fl. 2NDFUJOIC_sq.R. 3RDFLOOR_sq.A. BASEMENT p.R.
DECK_sq.¢. COVERIDDEC&—tai STORAGE aq.ft. OTHER—N.A.
GARAGE_p.ft. ANachd❑ DuacbedD CARPORT sq.fC Asrachedp Derrchd❑
MANUFACTURED HOME INFORMATION: 44 COPIES OFT'HE FLOOR PLAN REQUIREW
MAKE MODEL YEAR LENGTH
WIDTN BEDROOMS BATHS SERIAL NUMBER
ENDRONMIMAL HEALTH: _
an<
SEWAGOSEWER SOURCE: SEFnc SEWBi / Ni EUSTINOi
PLUMBING M STRUCTURE? YES NO❑ ��R��`t�Jye:,arlaµ(arrd Warn Adegwary Fpsm
PF]tUNETEWFOUNDATION DRAINS PROPOSID? -TtlPar" ( N EXISrING So FT.
EXISTING BEDROOMS PROMS®BEDROOMS OTAL BEDROOMS
OWNEfl acknm11d9e her sudni rew of lne—ate information may reauft In a fiord work order V Word levocalim.ArhriarMageman 0 sWl h by
slanatum hadw.I dWM Nat I am the owner and I fuller nation,tat I am elMba W Wanted he perms and to do the work a5 pupo'.at I Never
WNIned Parma slon onar m tM recessary lronles,Includlrg arty eazenmt Mldv IX pNtl N lnipest regarOing Nla poje0. TM1e4wru v l¢gal
anted Nudintratw endns Infotmetlan PrcNd�6BCCu21e enC 9retps emptry:95MMesM CWnry a¢essto NeaWwdpWIM1 ggaty
peddax]t. oils IranWalglk Eedena null&wld A wwk ar euVwrlxed Wnyrvc9on Is rwt¢mtnenx]MNIn tBJ
Wys IX tl mn9rvetim wore k5uspeMIXe N t on,ddys.
PROOF OF CONTINUATION OF K THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
ICATION OF 1 YS MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE IC K42)
re WOWNER M n ine
DEPARTMIi REVIEW APPROVED I DATE DENIED I DATE I TAGS/NOTFS/CONDHTONE
BUILDING DEPARTMENT
PLANNING DEPARTMENT
Wl
FIRE MARSHAL
PUBLIC HEALTH
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