HomeMy WebLinkAboutBLD2024-00041 - BLD CD Environmental Health Review - 1/12/2024 MASON COUNTY PermitNo:f/ILtR3C.41 �D
COMMUNITY DEVELOPMENT 1AN 11 2024
Permit Assistance Center,Building,Planning
615 W. Aid r S t
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: 144A4h
NAME:emaueArne,LLG NAME:Swnnelwncmemram RFC J11p14
MABdNGADDRESS:PDIUa TX MAILING ADDRESS:v Etl
CTTY:Abn STATE:WA ZIP:ill CITY:ftbur STATE:WA ZIP:
PHONE#1:2Ztlt-= PHONE' CELL: 'M
PHONE#2: EMAIL:aamXen uulltl wn
EMAIL: L&I REG#ea "l ENP._/_)_
PRIMARY CONTACT: OWNER P. CONTMCfOR 0+ OTHER❑ IjJ =
NAME n we", EMAIL I^^015a^•^wnw.m^ C J.
NAMING ADDRESS POM-1- CITYnX" STATE WA ZIpM24 C
PHONE '+ae CELL z Q
PARCEL INFORMATION: C) _
PARCEL NUMBER(12 Digit Number) ZONING
LEGAL DESCRIPTION(Abby,vWetl) FIRE DISTRICT
SITE ADDRESS MD-Aq AF.+ ne CRY Mann Z
DIRECTIONS TO SITE ADDRESS "e:.lmna-l.11e^.ew"v wweXEJal.wSp". leN-F.w..Ap .rzs muemlwmlw. LU
O MEPROJELTWRRDi300FFOFSLOPE(S)GREATERTHAN14%: VISO NOQ SNOWLOAD:2L_,sf
I3PROPERTYWITHINMn OFTNEFOLLOWING: rXd NlrM;A*,,
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONALRUNOFFD STREAM❑
TYPE OF WORK: NEW Di ADDITION[) ALTERATION D REPAIR 0 OTHER n
USE OF STRUCTURE(Rudm.,tlu g,C—Auk,,
ISUSE: PRIMARVDi SEASONAL NUMBER OF BEDROOMS X NUNBEROFBATHROOl
HEATED STRUCTURE: YES(wndeattV Di YES rycnAl*AW❑ NO❑
DESCRIBEWORKMwM llw
SQUARE FOOTAGE:bmwaeaA
IST FLOOR I— ,it 2ND FLOOR_stl.ft. 3RD FLOOR M.ft BASEMENT eq.&
DECK s,ft COVERED DECK_sq.R. STORAGE ,ft. OTHER4 It 5
GARAGE_, ft. AnaaAM❑ D uwiwl CARPORT s .ft Al❑ Du [3
MANUFACTURED HOME INFORMATION: •d COPIES OF THE FLOOR PLAN REQUIRED'
MAKE a's"""wr MODELFN "W N YEAR— LENGTH.
WB3THr BEDROOMS' BATRi SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGFJSEWER SOURCE: SEPTIC O' SHIVER I NEWS EXISTING[I
'+ PLUMBING IN STRUCTUREF YES❑ NO❑ lfJ .all mMfeled Water Adequary Form
PERIMETERJFOUNDATION DRAINS PROPOSED? YES❑ NO[] ExtsmG SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS TOTALBEDROOMS
dNNER eltmmNe3ys Nel wCmtsGan Ninewa+e imwmMnn mry rmuX In a pW ssoA ortler«pertri+rerocelbn.MknoMe]BemgtMwMi iabe
sgre+we�low.l Eelare Mal l am Ue diner aM NAM1er tleNare Hal eat en+Ned maee s o llve em,X "n M s pneM es pmlpe ra M2
.�+e Nte'metl pemiespn M1om 411+N ,n-unrypenies,intluain0 airy easemem XOWer orpeoks of lnon CoungerEin011iis pmlea.TlmwnwW bOM
S �epesenGlluv'mpeseMa MNtlu lnro�melTuproNaea I4BCNnd wmBnem-d ffsot Mason Lmnry rcess to MeeW1.—.lEM oopMy
«q eb�«VH 11wmNew ek Xupetlbn. lnis penmieepplXalion ESWmtt nu118 wiE Mxwk o�auMovea mwW Gon u nal mmme�vxtl xiWa 1m
aMt4 m XmnNl«5on wn a w4penaetl I«a penpa m+aD days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTNFTY OF THIS
PERMIT APPLICATION OF 1SG DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE Ican)
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$IgneWmof OWNER(Mlb PlRneEWNe OWNER I Date
'DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGSNOTES+CONDITIONS
BUILDING DEPARTMENT
PLANNDIG DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH
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A.) IX lnli.fR e'04" n'lD'6aMatklrmfoollinglouM311orm �{� {. ej}r
B)Septic tanks) eRu.,.o 4aelEackimm all Iootiiift. tiono 1 '!
C)No loundal "Ernler Drains wiMln 3*n,lo.,,adienl 0 ,l TES W"N DlanlielNResery won
D.)No CO Benk( �(gleeler Men Sfl and over as di within
sown erede ofD nfieWReservw area (`
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PAIIIT JOY JOHNSONt R
ONE
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