HomeMy WebLinkAboutBLD2024-00039 - BLD CD Environmental Health Review - 1/11/2024 MASON COUNTY Permit No: U I$ CA1�Y•t:f;*_ ��
COMMUNITY DEVELOPMENT 1AN 112024
Perini[Assistance Center,Building,Planning 615 W A Street
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: ✓ `y"Y.L,
NAME:Eaaaxaxre.,uC NAIMIli:swmmo,e canmtaean q 1 "'LL
MAILING ADDRESS:FO IbaM MAILING ADDRESS:PO 3-m p IZ
CITY:Alp STATE:wA ZIP;°Bsxe CITY:BNu° STATRWA ZIP:°HO° C n
PHONE#I:xgsxoOBus PHONE: CELL: '�S�tSN
PHONE 42: EMAIL:ed,menpre Z
EMAIL LAI REG#B.exeut EXP.
PRIMARY CONTACT: OWNER3 CONTRACTORa OTHER❑
NAME TMsis. EMAIL WmmN«reaxollsrmn
MAILINGADDEESSFNBnx° CIww STATE WA 9P°BBm Ow
PHONE Ne'$aam CELL N
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) ZONINGSF z
LEGAL DESCRIPTION(Abbr ,ovd)_ FIRE DISTRICT LLJ
SITE ADDRESS MID-App=25i'mus. CITYS•n^^
DIRECTIONS TO SITE ADDRESS N.a.^eea t.n.b eay a..rmap•n..eaip x, test pas t...nppina.sxsnax paon t.a
IS THE PROJECT WITHIN 300 FT OF SLOPES)GREATER THAN IdA: YES[] NO[] SNOWLOAD:2�0 d
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: A'eeamltBmWpp:
SALTWATER[] LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONALRUNOFF❑ STREAM[]
TYPE OF WORK: NEI ADDITION❑ ALTERATION❑ REPAIR❑ OTHER n
USE OF STRUCTURE(r amerev,rm,y(a,co—e�sis.E's)N.m...
ISUSE: PRIMARYE] SEASONAL[] NUMBER OF BEDROOMS?NUMBER OF BATHROOMS'
HEATED STRUCTURE? YES r w,,BW�+ YES IPanla]nJAWrJ❑ NO❑
DESCRIBE WORK Nss Mb Ho
SOOUARE FOOTAGE:&, oo t)
IST FLOOR tin sq.R. 2ND FLOOR sq.R. 3RD FL00R so.R BASEMENT .it
DECK_aq.It COVERED DECK sq.O. STORAGE p.R OTHER ,A
GARAGE_sq.R AvarheE❑ DesacMd❑ CARPORT ol.R Agoi[] DaacAW❑
MANUFACTURED HOME INFORMATION: ed COPIES OF THE FLOOR PLAN REQUIRED-
MAKV— MODELSeNaN YEAR. LENGTH ea
WIDTH27 BEDROOMS- BArFg2 $F3tW,NUMBER
ENVIRONMENTAL HEALTH:
SEWAGFISEWER SOURCE: SEPTIC O+ SEWERS / NEW Di EXISTING❑
PLUMBING IN STRUCTURE? VIES NOS (/yrs,pmUrconp/antlWinnAdegxaryPa—
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NOD EISTINGS(I.FT.
EXISTINGBEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS
OWNE0. bss— Ia°eamalWEam9ende,andientrdwntry reaMeaAopmMoNarapemxnwcatpn.MknwSpa , ,Ieutlila Ly
alvnaarct-so attJare III Iammeovine,anoI NnMroeaare tau am.dines toreces Isspelt.etabao Me .ea prppp56a. nm
cMmss pe�tlanonssM ttIthenecessaryon .dual.°anyaeand tatopermpaN dotnlere9,*toosmlto eeab TIe WFieed prop1
repreaemative,rtpreaerna Inel me InprmTlon pmNaM Is eavrerc me Bmis employees d Meson County aaess to Me stove aescnOea pmperly
atl cr ffwn(c)t«reNex ma Inspacnon. tic petmNepks)day.cewmes wn B vola nv,«k«eunwnma mncW clbn x nd wtmer¢a velkn Leo
aeye«mm�awcean wn're eayenaea mra penoa a Leo aeya.
PROOF OF 'ONTINUAT II OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT PLICAT N OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TOM E)(PIRED.(MASON
COUNTY CODE 14.00.42)
$greWteWOWNER(Muss,be ekneE by ibe MN Due
DEPARTMENTALREVIEW APPROVED DATE DENIED DATE TAGSINOTESICONWITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FEE MARSHAL
PUBLIC HEALTH
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