HomeMy WebLinkAboutBLD CD Environmental Health Review - 10/18/2023 Permit NR" 4 t D
MASON COUNTY
COMMUNITY DEVELOPMENT OCT 17 2023
PerMt Asslslance Qn[ep widin8.Pbnni,
BUILDING PERMIT APPLICATION 61 ktree
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PROPERTY^O'W,NN,ERRIa..��INFOR.MAA(T�ION: CONTRACTOR INFORMATION:NAM& (e W At0"5 NAME:MAILING ADDRESS: MAI ING ADDRESS:CITY:A[tmW%4 STATE:W ZIP: S CITY: STATE: ZIP: m
PHONEM PHONE: CELL:PHONE A1: EMAI-EMAIL: C.K.Cr $.dQ,REOA EXP.
PRIMARY CONTACT:: OWNE CONTRACTOR OTHER[ ~
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NAME EMAIL 1�
MAILINGADDRESS CITY STATE_ZIP_ D Z
PHONE CELL g
PARCEL INFORMATION: tt: ZRA Imo= rn
PARCELNUMBER(IIMON:mb¢) ZZI Iy^L 1, 1002-0 ZONING z
LEGALDESCRIPTION(Abbreviated) [( � � PIKE DISTRICT
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SITEADDRESS wicz 'a'eeptg: w^V CITY LTf�sYs-'•I r—
DIRECDONS TO SRE ADDRESS
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18TIIEMR CTWTTHIN3NFTOFBLOPE(S)CREATERTRANI4%: YESQ NOVA SNOTPLOAD:�d
IS PROPERTY WITHIN IN FT OF THE FOLLOWING: ttaatvoAa avvbJ�
SALTWATER LAKE❑ RIVERICREEK❑ POND❑ WETLAND SEASONAL RUNOFF STREAM❑
TYPE OF WORE:: NEW Rf ADDITION 0 ALTERATION U REPAIR❑ OTHER ❑
USE OP STRUC1l1RF p.ewam,eanx<anaamsel a14 se)
ISUSE: PRIMARY SEASONALO NUMBEROFBFDROOMS NUMBF,ROFBATHROOMB
HEATEDSTRUCT T YFSOr BW YESryWldB*jO NO[]
DESCRIBE WORKw C
SOUARE FOOTAGE:&—II
1STFLOOR 4^agRaq.It 2NDFLOOR sq.ft 3RDPDOR sq.O. BASEMENT_aq.R
DECK aq.ft COVEREDDWK_Jj—�—aq.ft STORAGE aq.IL OTHER %&
GARAGE q.ft A.,W[] Demahed❑ CARPORT eq.ft Aoaahed0 Drl-W11
MANUFACTURED HOME INFORMATION: e4 COPIES OF THE FLO IRPLAN REQUIEM'
MAKE MODEL LENGTH
W10 BEDROOMS BATHS SERIAL NUMBER
i ENVIRONMENTAL HEALTH:
SEWAGESEWERSOURCE: SPPTICfI NEW EXISTING
PLumEm IN STRUCTIRIE'! YES fr NO❑ iJyw,allach cpmFleled Wow Adegsmay Form
PERMETER/FOUNDATION DRAINS PROPOSED? YES❑ NO� EIOSTINGS%FT.
EXISTING BEDROOMS PROPOSWREDROOMS�_ TOTALBEDROOMS�
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n0^aNn Eebw.l4atlert Mrt I am Newner anE I M1UNertleWrelM1et I vn mtltletl bnolm Nk prmtl enE to Eo Me vak ea pmpseJ.l M1eee
oElanatl pemmavon lmne1tM1e neml— -a mCWm myuumen:hd0er orpstiw Winleren repeNing:nla pr^pd. IDe^wnaor blel
mp Rlem m(9repma Winelnlmn.Y �w�EW isle Y n m—.W,mNoyMaNMum County aco�Y.-1 above JeS n-pmpaty
I gefLon ap80da 0aemrm nYll8 v4dilavk orauTonzaE mnertuctionie%wmmanceO waM1n 100
mye w Hmnsauctim vxM1 ie augmtlatl br a penM W 1B0 tlaya.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT A9 ATK)N OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO RE EMRED.(MASON
COUNTY CODE 14.WA )
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DEPARTMENTALREVIEW APPROVED DATE I DEN= DATE TAC NOTESICONDRIONS
BUILDING DEPARTMENT
PLANNINGDEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH J
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