HomeMy WebLinkAboutBLD2024-00003 - BLD CD Environmental Health Review - 1/4/2024 • Permit No: SLnn�o�T'�3
MASON COUNTY RECEIVED
COMMUNITY DEVELOPMENT
P nRA�Em�rD,� B.IM�,P1.Mlne JAN 022024 m
BUILDING PERMIT APPUICATION 615-W.Alder Street Z
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PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: _ —x
NAME:"Sa NAME: m O
MAD-AIG ADDRESS:=1 wswsw veym MAR NG ADDRESS: D Z
CITY:Bbems STATE:WA ZIP:9Sss4 CITY: STATE: ZIP. t--'
PHONE#1: PHONE: CELL:
PHONE#2: EMAIL: = In
EMAIL:Mgmv nDft +mm L&IREG# EXP._1-1 Z
PRIMARY CONTACT: OwNERO CDNTRACTORD OTRERQ D
NAME�um. EMAIL mm.laM�saaWroOpMIRIemn (�
MAILING ADDRESS MU BEa1aRa BIA.Bu[s RD CITY T STATE MA Up W
PHONE Inaaz.n CELL
PARCEL INFORMATION: �fi lr
PARCELNUMBER(U Digit Number)419Y1"1MY121 ZONRNGImreIRSle.melsAwn ulJ
LEGAL DESCRIPTION(Abbmriehd)FCII OFMAW-74 PIN WIM NENW531M3 FIREDIETIacTIS JAN 04 2024
SITEADDRESS=WB VAft Re Cnyy
DIRECTIONS TO SITE ADDRESS RECEIVED
MS PRWECCWIP®N30EPFOFMOM(S)GREATERTBANI4%: YESQ NOD SNOWLOAD;25—Pfi
MPROPERTYWTEHININFTOFTHEFOLLOWDNC: rt'kdm�rmeappy/:
SALTWATER[] LAKE[] RIVER/CREEK[] POND[] WETLAND[] SEASONALRUNOFFEI STREAMO
TYPE OF WORK NEW Q ADDITION[] ALTERATION[] REPAIR[] OTHER R
USE OF STRUCTURE(Rm ,,C. .C.w.. Sft..4r.DR "a
MUSE: PRIMARYEI SEASONAL[] NUMBEROFBEDROOMS3 NUMBER OF RATHROOMS4 _ —
HEATED STRUCTURE? YES/mdaRwl[] YES/Pw/afaug,[] NO D
DESCRIBE WORKC&"b ?9-ICrHemR _.
SQUARE FOOTAGE:
ISTFLOORIL7,; ft. 2ND FLOOR_sq.R 3RDFLOOR aq.R EASEMENTju sq.fl
DECK N.R. COVERED DECKI000 sq.tl STORAGE 4ti NAIL OTHER aq.ft.
GARAGE_6of_I.& Armehed .0 Demrhed0 CARPORT MAL Amdled❑ A ,W[]
MANUFACTURED HOME INFORMATION: •4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL EMALTH:
5EWAGF EWERSOURCE: SEPTICO S ,ER O / NEW El E)aSTNG[]
PLUMBING IN STRUCTURE? YES 0 NO[] UPas,mmrh ronlp(ded IPatn.4dm4 Forty
PEIUMETERTOUNTDATION DRAINS PROPOSED? YES I] NO[] EXISTINGSQ-FT.
EXISTING BEDROOMS 0 PROPOSED BEDROOMS 0 TOTAL BEDROOMS 0 _
OWNER rkwvlsd s Cal su6ns®n dm=e le mlo-matien nay reW W.abpxor4wErn ppmgmq.gun.Mwammf liytt dr iby
eipvlua bem ,Id.tlue I m Its Oamei.nd l mmrer LecYretlW Iam m rests Nisp .w mM IMr .P .I.
oBaineE pxmaaion fivn ae Me recessary pa2n.ftw, V.06.Tre owura Iqe
r.P,.s.nmc,.,,aP�e„n Ih#tla minmamn Provweb�s am,rela ana ymns engyee:aM.ean Caumyavess mmeabma4nom.a PnoeRr
eMsbvslure(sl ru reYcv ad u�sFec mr a da b pgemld 100atian tecpnes nupawN JxwhoraNYmizetl cpnsw[tiananam�nmice!x;F'n 1N1
a aya �aam'w�.ahsuswnaae anoadlea says.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF TNIS
PERMIT APPLICATION OF 1 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPRED.(MASON
COUNTY CODE 14.08.42)
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spram.d ER(Mutt be.mn"Wtb.OWNER) T' / me
7uARTM6YTAL REVIEW APPROVED DATE DENIED DATE TACS/NOTPSICON-DITIONS
BUILDWG DEPARTMENT
PLANNING DEPARTMENT
FIRE MP.RSHAL
PURISCHEALTH t,L
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