HomeMy WebLinkAboutBLD2024-00044 - BLD CD Environmental Health Review - 1/12/2024 Permit No:�Ie G6T_SLL/IfI y`D
MASON COUNTY
COMMUNITY DEVELOPMENT JAN i 12024
Pa¢ml[AUlflarce QsrtA,9WIdIN,NannlR
BUILDING PERMIT APPLICATION 615 . Alder Street
PROPERTYOWNEA INFORMATION: CONTRACTOR INFORMATION:
NMAILING
ADDRESS
: LH1 R.ik,,, 1d904,#4
MAE,MG ADDRESS:
CRY: (M2LJGN STATE:,,' ZIP: 40Y9✓ CRY: STATE:
PHONE '/3 PHONE CELL: 1p
PHONE#2:� EMAIL: l�
EMAIL: J, :1- d t J LRI REG# EXP._/_ z
P YCONTA OWVR� CONTMCfOR❑ /OTNE Lu
NAME A 4 L A EMAIL, I.t, V's�L'�?rk^f'/�•w
MAILINGADDRESS CITY STATE—ZIP— z Q
PHONE all
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PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Nasnbc) T/91/< uv : 6Q ZONING R.1:el.+t l
LEGALDESCRIPRON(AbbrevuW) r SITEADDRESiS GO Bl sV. Wa z
Or CITY ( A.
DDIECONSTOSITEADDRESS L ✓ * 7rc+ z
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ISTHEPAOJECFWOMM3Wn OFSLOPE(S)GREATERTHANIJN.: MI] NON SNOWLOAD:,_Prf
LSPROPERTYWT1RN2EEFTOFTHEFOLLOWEJG: F,taetmlum,Fyy/:
SALTWATER❑ LAKE❑ MVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW❑ ADDITION U� ALTERATION(IREPAIR(IOTHER ❑
USE OF STRUCTURE..,(w¢ma�s,Camra Caa+wmal nun.&cJ R,. I+e_ _
ISUSE: PKIMARYM/SEASONAL❑ NUMBEROFBEDROOME_ _NUMBEROFBATHRCOMS_
HEATED STRUCNREx YES( Bd(i1 NO(I
OESCR®E WORK Z E G ad
SQUARE FOOTAGE:puoymap
ISTFLO0R_2#,6__sq.ft 3NDFLOOR_sq.ft JRD FLOOR_sq.R BASEMENT_N.ft
DECK :L1 N.ft COVERED DECK L4,L sq.ft STORAGE sq.ft OTHER_K ft
GARAGE_sq.ft Aths ied❑ Demchrd❑ CARPORT sq.ft Availed❑ Desnchedo
MANUFACTURED HOME INFORMATION: •#COPIES OF THE FLOOR PLAN
MAKE MODEL GTH
BEDROOMS BATRS SERIAL NUMBER
ENVIRONMENTAL HEALTH: �/
SEWAGPISEWER SOURCE: SEPT,I�C/LT SEW INER❑ / NEW❑ EXIST
PLUMBUNGINSTRUCTUREx YESL{ NO[I If,,aNaehcdpined Wmer Adeg Farad
PERIMETER/POUNDATION DRAINS PROPOSED! YES❑ NOu E)GS11NG SQ.FT.y�
EXISTING BEDROOMS Z PROPOSED BEDROOMS O TOTALBEDROOMS_-Zr—
gVNER c ma i demand
I am 9m NneWaek der de an mey 1 am ar a Yop me a uss permq n nd to d m.M as ppemeM N eWT Ia Ey
tlpnamre Edcw.l E¢Wanas d am IMaxereneI'Mad any
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¢apexnW.e, aw.. sMm Me iMomelbn.'nowk asacm negmu &m d IsNMason Lwnry ewes¢'NeeM.+oeeai�lprtpwtY
sW¢a ff dons Mnwex is Nspedion.11tls flag 01 Btcii,n Mwmes nWl6 vvEMw.eko¢autlnezee cenamidkn I¢Maanme�caoxltlen 1B]
oryaa tlmnaNCEan vroM N ausyenoeo fore penoo oI1�oye.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTMTY OF THIS
PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY LODE II.0A3)
z ��y4y Dots
SpreWre MOWNER( b etlbM OWNERI
DEPARTMENTALREVIEW APPROVED DATE DENIED DATE TAGSMOTFS/CONDMIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH T
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