HomeMy WebLinkAboutBLD2024-00104 - BLD CD Environmental Health Review - 1/31/2024 Permit No: BLLL � -XK4
MASON COUNTY RECEIVED
COMMUNITY DEVELOPMENT
Pmml[Assbmnce CenfeABuildm PlannIne JAN 2.4 2024 z
BUILDING PERMIT APPLICATION <
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: nl O
NAME: i NAME: D Z
MAIL
A1 DE S: MAILING ADDRESS: 1'
CITY: STATE:wa ZIP:, CITY: STATE: ZIP:
PHONE#1: U.-Za6-4Y.r2 PHONE: CELL: = m
PHONE#1: - o 4 O EMAIl.: Z
EMAB.: L&I REG# EXP.
PRIMARY CONTACT: OWNER® CONTRACTOR I] OTHER[]
MAMEMAME 7E L!w EMAIL �J �i.C�
MAl NGADDRE0 S41 CITY-Ch.l STATE r�•M1 ZIP99f�rn,.
PHONE 3[A-2af. gNSi CELL As
PARCEL INFORMATION:
PARCELNUMBER(12DiEtNumbeO 47-111 - 19- 90033 ZONING IIEGALDESCRIPTION(Ab�imed)
L,+ 3 -C 50 tt ILeR FIREDISTRICTSITEADDRESS 91 W We&Ucr CceeK L.. cITY J014
DIRECTIONS TO SITE ADDRESS SR
M MEPRWELTWTTHI 3ME OFSLOPE(S)GREATERT NId%: YESD NOZf SNOWLOAD—f
IS PROPERTY WITHIN 2W FT OF THE FOLLOWING: RFVT11a Wol
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND[] WETLAND❑ SEASONALRUNOFF[] STREAM[]
TYPE OF WORK: NEWg ADDITION❑ ALTERATION REPAIR OTHER Il
USEOFSTIUJ=IE(xum,..e.&r Caw.oa ...) Mee Ae"_soil
IS USE: PRIMARY SEASONAL❑ NUMBEROFBEDRDOMS NUMBEROFBATHROOMS I
HE4TEDSTRU(7TURE7 YRRrW Rkfg)❑ YES(ran/)ySlWp NO❑
DESCRIBE WORK
SOUARE FOOTAGE:(Pmpu.O vnhtiLfeci tit6T'CL
IST FLOOR1eL N.ft 2ND FLOOR—�p.ft 3RD FLOOR aq.R BASEMENT_sq.ft
DECK eq.R COVERED DECK - N.
k X\l'ORAGE Ic/N.ft OTHER q.&
GARAGE 3Nq N.ft Attached[] Anm&d❑ CARPORT sq.ft. AoxA D Dm []
NIJFACTURED HOME INFO? I THE FLOOR PLAN REQDREDa
MA YEAR LENGTH
WIDTH S BATH$ SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGEISEWERSOURCE: SEPTIC SEWER❑ I NEWd EXISTING❑
PLUMBINGINSTRULTURET YES NO❑ T/Pea,attach cmWe+ed Weer Adeq gFoem
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ N EXISTING SQ.tT.
EMSTMGBEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS I
OWNER MYnm ,mi InMsubniaoon NinaauMM InMmYMn nwe neJl Ina Map roMaMawmN rtwmllon.IdnwMOaemeMOlwTIeb/
slpnaWre e.n"w ..mM em MeormerenE NuoIll eRtlW lemon.Oto ncaf uPmm4eMmEameI e¢g—.1 .9W
aN.inaa wimbaion rmm m ma repo:ory pores:.maaoina am oawmoM noiem or wMe.a'a:mM regw�nv mis wgoM 1n<amerarapm
anus etlw.rePmamand Pe Nlo,melro spo iti iesuvnb cops null
mdKe teeonGwny ammes nnI GewRee pµMy
om ewmxNq forrewow one won. ms pewiuoppllraeon eemirea nan a.dp nwn oreallouee aanmaaw b nM ammomaa:a,in IN
e.y.or mm�.wmw wn a eaymaea mre va�oa M�aq eoye.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF 1E0 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.06.42)
Shf4ricV01111NE w won"b the DHa
DEPARTMENTALREVIEW APPROVED I DATE DENIED DATE TAGSMOTES/CONDITIONS
BUHADIG DEPARTMENT
PLANNING DEPARTMENT
FDUEMARSHAL
PUBLIC HEALTH S
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