HomeMy WebLinkAboutBLD2023-01192 - BLD CD Environmental Health Review - 10/5/2023 Permit No:
MASON COUNTY RECEIV o
COMMUNITY DEVELOPMENT p n
Pm4 ssIsUnmCenWrMWir NamtM OCT 04 2023
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: J
NAME:S09CQn><Ha\ie ►nCQU�\\Q'[\ NAME: �\Li'neme,S
MAE. GApDRESS:FO�I Yam. — MAILINGADDRESS: \1 WO VC. z
CITY: '� STATE:W ZIP: a CITY: O\U STATE:V4 ZIP:
PHONE pI 2 '.tP11M PHONE:2 U.J
PHONE H2: EMAIL: LN rt V , hi%`i J
EMAII.:�S •CDM I.&A REG EXP.I /_/ z Q
PRUTARY CONTACT: OWNERffi CONTRACTOR ER I� CDLU
NAME Q\1\\\Qn EMAIL� I�\GE�O COM C
MAILING ADDRESS "W�A IWO CITY \T STATEA&Lb1 ZIPS '—O
PHONE 'N1ad % NI,1%6 CELL
PARCEL INFORMATION: w
PARCELNUMBER(1ZDipt Numbar) Ia39q-IS-o000C) ZONING
LEGALDESCRIPTION(Abbmiatcd) FIRE DISTRICT SUE ADDRESS \50 NE-V05 e'f CITY %0- bSf
DDtECIl\OWONS TO SITE ADDRESS TQ \nS m rOM o1A Y�C \ u/
Fo\ ko-Haa. trd U-ct a_ � 'sw�2n er ntt. s
ISTBEPROJECTW1TxIN3N"OFSLOPE(S)GREATEATB 14%: MCI NOX SNOWLOAD:---pe(
ISPROPIM 13 LAKE[] FErrmci FOLIAWIND (cnrrETLAmO1
SALTWATER❑ LAItE❑ RIVER/CREIX❑ POND❑ WETLAND O SEASONeR.RUNOFF 11 STREAM❑
TYPE OF WORK: NEW,X ADDITION❑ AL(T�ERATION 0 REPAIR❑ OTHER ❑
UEE OF STRUCNREAA(pmlbe GmN..Cuemn[iol8ldy fire) YT\MQT OJ �PS\�Q
1SUSE: PIUMARY)§ SEASONALQ NUMBEROFBEDROOMS NUMBEROPBATEROOMS a
HEATED STRUCTURE? YES(wna.rmy YES Wa eve D NO❑
DESCRIBEWORKNE\rJ �'�'(\ C3t\C'C\
SOUARE FOOTAGE:Nmpmat,
ISTFLOORaabasq.R " ipD�FyL3OOR aq.R 3RDFIAOR_p.R BASEMENT_p.R
DECK p.R COVFAZJ�EDTIERK 7.4I soft. STORAGE sq.R OTHER .&
GARAGE52, soft. Atlacbedj( DetaaW0 CARPORT s.R AU=W[3D hedO
MANUFACTURED HOME INFORMATION: e0 COPIES OF THE FLOOR PLAN REQUIREDr
MAKE MODEL YEAR LENGTH
WD)TH BEDROOMS BATHS SERIALNIIMBER
ENVIRONMENTAL HEALTH: ..,,{{
SEWAGErSEWER SOURCE: SEPrICg EXISTING
PLUMBMG W STRGGIUREI Mg. NO Q IJyaa,arpra,h coarplalad WowAdegaary Form
P]MDdETER/POUNDATION DRAINS PROPOSED? YES NO13 EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSEDBEDROOMS � &�T(Utad MDROOMS
Sir—
(WIN—M eMVMaeva¢rad¢ulanieaiuri alm¢¢urM Inkmierbn my reaun In a stop work craw ar pmmft mv—..Pb upinatvamwda Wdl kky
agneWre lnlaw.I aeaare M4 I am the wmar all I fuller tleckre Mat I em mrmatl to mane,an.ceimX and to ap mass.e¢Iagn¢ee.I.
soared pxmk¢on hom all Me n.—q Pa..inclutli,,aassi nokler or parries or Imarest re0ar5rm.gyed, me owns an kyl
rpauentalrve,regesan6lha Me IntwmaWn povNatl i¢axume and vnMs employees a Mawn Counry aveu to Ne abarx tlasmb]prcprty
and abuwrN¢)tar raviewann inspection, lnh vmnNapplketlon[ecwmm null&w,d 0 wall or auMonxed oun¢Wvtian u natmmmerced vMin 180
dooro COnat donmv Nauapmdedfmasanda IW"q
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTNITY OF THIS
PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COINNT(CODE 14.08A3)
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Vial line ma OWNER) Dab
DEPARTMENTAL REVMW APPROVED DATE I DENIER I DATE I TAGSMOTES/CONOTDONS
BDaoING DEFARTMENr
PLANNINGDEPARTW3NNT
FIRE MARSHAL
PUBLIC HEALTH I
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