HomeMy WebLinkAboutBLD2023-01351 - BLD CD Environmental Health Review - 11/13/2023 PEI NO:
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MASON COUNTY RECEIVED
COMMUNITY DEVELOPMENT �If1Y� Elm
Pa to islanse Qnter,Builtlis Planning NUV - ( L
BUILDING PER MITAP o NOV 1 3 ZOZ3
PROPERTY treet
OWNERIN RMATIox: CONTRACTOR INFORMATION: RECEIVED
NAME:",..A Sliecwela.f NAME: (. LLL
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MAILING ADDRESS:1eoo A.1•,u lglL At NV MAR,EJ ADDRESS: L III
CITY:-o`,...;- STATE: WA AQCDi CITY:"I- MM STATE: Z
PHONE#?I,VM) 13f-S1i_I PHONE^I 1.
PHONE q2: EMAD /(. Ia I _ M
II.: ..-.�1 c..� I.&S REG#EMAIL �. /�1/
PRIMARY CONTACT: OWNER❑ %C(WRAETORQ OTHER❑ M O
NAME T/ EMAIL > Z
MAILING ADDRESS CITY STATE_ZIP r Z
PHONE CELL
PARCEL INFORMATION: �11 Z
PARCELNUMEER(12ftit Numbe¢) �d��(] �� IdOOI�.. ZONR4G
LEGAL DESCRIP]I0N(Abbmia ) .Dti ALw FIRE DISTRICT
SITE ADDRESS CRY VA 160
DDtF,CTIONS iO SITE ADORES J
LSTREPAOIECFWI'EHM3 nOFSLOPE(S)GREATERTNANI4%: YESD NOid SNOW LOAD:---,d
ISPAOPTERD IHDi200 FT OF IUEEKLOWDVCD IC WETIAaypy):
SALTWATER❑ LAKE❑ RIVER/CREERD POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPEOFWORK: NEWF2 ADDIDON❑ ALTERATION[] REPAIB❑ OTHER ❑
USEOFSTKUCIURE(Amm,¢4Cmg.Cwm Mdl,,.Ee,) ACS�I.eur�
IS USE: PRIMARY R SEASONAL❑ NUMBER OP BEDROOMSJ_NUMBER OF BATHROOMS_
HEATEDSIRUGIVAE9 YESraN.euupy NOD
DESCRIBE WORK
SQUARE FOOTAGE:&m,.o
IST FIAOR L%p sq.ft 2RD FLOOR 'LA I aq.B. 3AD FLOOA sg ft BASEMENT sq.ft
DECK sq.ft COVEREDDECK aq.ft STORAGE N.ft OTHER aq.ft
GARAGE sq.ft A—a O Dera D CARPORT ,OIL Ar o D.hd❑
MANUFACTURED HOME INFORMATION: a4 COPIES OF THE FLOOR PLAN REQUIRED•
MAKE MODEL LENGTH
WIDTH BEDROOMS BATHS SERIALNUMBEA
ENVIRONMENTAL HEALTH:
SEWAGUSEWERSOURCE: SEPTIC•® SEWERD / NEW❑ ImsTWG❑
PLUMBWGWSTRUCN YES.fl NOD If,,,aweh..Ol .d W.-Ad, Form
PFRIMETER/FOIWDATION DRAWS PROPOSED? YESa NOD ESISITNGSOFT. ✓I
EXISTINGBEDROOMS I PROPOSED BEDROOMS TOTAL BEDROOMS_
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oEtaMM q�mntlmhom el dnl arecemaxM1 OveulFtlue'np Meevemlmllcgmw4aNp UFlxe�hieORe�tlti¢PNe�Te�axn¢�ubyl
mpe¢9nlNse.repesvai MM tle nlwmtlMn goWe]is auvnh aM ereN¢e'Rao)sres N AYmi Lauey ecess to ttie Now EesulEM pepeey
mk svuaurels)ru refewem irmpemon. min pmnXlapq�on eemmrs null a wie nxm uawwvee mnseumon¢ml mmmenree rmin t80
e.y¢re emreeamon»ax i¢.u¢P.igN m a Penoe a two ear¢.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF IN DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.M.42)
X C I �7 /23
Sgrewre of O'NNQi(Moat M ekretl by Dm OWNERI 0�
DEPARTMENTAL REVIEW APPROVED DATE DEN6.D DATE TAGSWNOTEWONDTTIOM
BUDDING DEPARTMENT
PLANNWGDEPARTAQNT
FIRE MARSHAL
PUBLICHEALTH
D
C
1111/2023
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