HomeMy WebLinkAboutBLD2023-01396 - BLD CD Environmental Health Review - 11/16/2023 MASON COUNTY
COMMUNITY DEVELOPMENT m
Permit Assistance Center,Building,Planning
BUILDING PERMIT APPLICATION 6151,,; _ X
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: D O
NAME: s ; 2 NAW:Al/LIC
MATLwG AnnREs : Man,wc AnnitFss: rn
CITY: STATE Zr CITY: STATE: ZIP:
PHONE#I: A l ZI r PHONE: CELL; Z
PHONE#2: t — a EhWL: nn
EMAIL: 1 ,Gt •Cwrl LgI REG# EXP.
PRIMARY CONTA OWNS NTIIACTOR❑ 0THEI 'JWa os Dor�
NAME or eMAIL
MAIUNGADDRESS CITY STATE ZIP w
PHONE 31lI-W b4.1194 CELL O r•) 91
—
PARCEL INFORMATION:
PARCEL NIIMBER(12 DiSic Number) I'a,331--0-0011a ZONING
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT
STTE ADDRESS QC1 NE 1,eOH CITY
DDIELTIONS TO SCTE ADDRESS G LP �}1,
M=PROIECTWI'rM"nOF5 M(S)GREATERT 14%: YES NOib SNOWLOAD:�psl I :Uf Logo ,
%FR0PERTYWITBIN200FT0FTHEF0LL0V;1NQ. ICvtml waaygy: A' E 1J
SALTWATER❑ LAKE❑ RIVER/CREIX❑ POND❑ WETLAND❑ SEASONALRUNOFF❑ STREAM❑
TYPEOFWORI: NEW ADDmON❑ ALTERAn4QN❑ REPADI❑ oTTIDt C[ n
USE OF STRUCTURE Mh..Cm 'CavoddBlt r ,) L
, Jent e-
IS USE: PRBAARY* SEASONAL❑,` NUMBER OF BEDROOM$ NUMBER OF BATHROOMS '
HEATED STRU S Nv -_Wn[I YES ryw/aJaJ ❑ NO
DEscRmewoRx rrr"lll G i W —A .,pMjtred
SOUARE FyyO����O�T���AGE:omPomq
r1a1=ae
ISTFL00RJp71V,11 219DFL00R aq.A. 3AD FL00R aq.ft BASEMENT DECK u,.ft COVERED DECK p.ft STORAGE ml.ft OTHER W.ft
OARAGE ul.ft Atnu W❑ Detaehed❑ CARPORT N.it Ado o Dem o
MANUFACFURED RO 'ME 1 ' INFCc0RMATI0N: •d COPIES OF THE FLOOR PLAN R(EQUMED-
MAKE ICLACS en YI(:PA�FIODEI,'nf!d.VY) YEARaca:3 LENOTN�
WIDnI _.BEDROOMS BATHS_e�L__SERW.NUMBER 44j8&>
ENVIR0NMENTAL HEALTH:
SEWAGWSEWFASOU : SEPnCN snwER❑ I NEW❑ =STWGX
PLU WGDISTRUC11RE) YES NO❑ a�I'[yT� TYy mmdaorryt dR'merflog yForm
PERIMETEREDROO S-9-- PR OPOSEDMBEDROOMS NOD t� TOTALBIDSROOMS�
EXISTMG BEDROOMS
GONER aWgMw1]e¢Pal adnYYm or Yiemnw iiRwmalbn mM revull In a aMpvM n<mw Gamil,extlYn.M4vMaM1XmeMNeM aEy
sgt°mva MM.Idtlae tlut am tlk wrerak NMm wye Paliem deroro.tt— . pem0 yqm WtlkveN,vs poposeE.l luw
oaV1N palini¢aiCntmn eII1M,w[e¢ssy peNas intluE'ey any eeaemeM IMGe,o,path dinlere&temp tlis pFp4 ilia oxiree or kptl
regesatlaP.a,rePesem¢malnK lnrolmanpn ptoaaaa'uamam as Pains mngnreesa Nason eountya�nsmPe.bo.:ae nMe pmpetry
a,a am.7.ure(s)mr reww em iny,xmn. mia ceonuapgivaon eeoomes tt�u a wia n swn or aulms:m outwtumm is nm mmma�wmm tin
dar¢otrm�waaoa wmx is.:u�amee mt a oenoe or Teo aaya.
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 14.08.42)
X z5ca��.v o-g- 10-a-23
Sgnah M OWNER O W be°i°netl by the OWNER) Daf
DEPARTMENTAL REVIEW I APPROVED DATE DENIED DATE TAGS/NOTFSICONDTTIONS
BURRING DEPARTMENT
PLANNWGDEPARTM1ENr
FIRE MARSHAL
PUBUC HEALTH
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