HomeMy WebLinkAboutBLD2023-01076 - BLD CD Environmental Health Review - 9/12/2023 MASON COUNTY Permit ND:-&,b2D0L07(o
COMMUNITY DEVELOPMENT RECEIVED
Permtt Assistance Center,Building.Planning StP 0 $ 20
BUILDING PERMIT APPLICATION r Street m
PROPERTYOWN/ER INFORMATION: CONTRACTOR INFORMATION: Z
NAME: to 13p4r I n N
MAILING ADD ESS: [ Sd v MA IN AT� S:
CfrY: S�rllcn STATE:vA ZIP: 'YSeH CITY. n STATE: ..�k ZIP:G bSN+Y
PHONE#1: NLS= h/Y- 5NL PHONE: 3LC-411.GU) CELL: — D Z
PHONE#2: EMAIL: +.:L. be atFe .r11 1+e. ao n
EMAIL: 'r.. !- •F L&i REG# .1g 11 EXP.Y /�1/� ,�,I F.
PRIMARY CONTACT: OWNER[] COWMLTDR�', D'1'118Ro I Amy
NAME CPn�// ENAIL G
MAIWNG S Cf1Y f.,n STATE iJh ZIP iSEi1 „I
NPEEi
;- 't - '8 ' CELL 16C - �J�7YC4 D
FORMATION:
BER(l2 Digit Number) 32U2 7f Uc:luC' TONij
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RD'IION(Abbsavlet� _R IC 4//r Y' FIRESE1 22023 FS '/Ki.' SE L'n✓,r: E:. rn' FF TO SITE ADDRESS RECEIVEDJECT WITHIN 300"OF SLOPE(S)GREATER THAN TeX: YES[] NO
ISPROPERTYWITH1N200FTOFTHIFOLLOWING: Read arrmrappyl:
SALTWATER[] LAKE❑ RIVER/CREEK® POND® WETLAND® SEASONAL RUNOFF[] STREAM 9
TYPE OF WORK: NEWU ADDITION[] ALTERATION[] REPAIR[] OTHER []
USEOFSTRUCTURE(Noumm..,FM.[w.) r f:s'C it
TSUSE: PRIMARY® SEASONAL[] NUMBEROFBEDROOMS 1 NUMBEROFBATHRODMS I
HEATEDSTRUCTUREI YES(whaaBJay YES lva.s(al Na/kr[] NO❑
DESCRUJEWORKk '1O IS f- c
SOUARE F--OIICCOnnTAGE:�.dl
I ST FTAORJaA�p.fl. 2ND FLODA�p.fl. 3RDFLOOR If, BASEMENT p.ft.
DECK p.R COVERED DBCR p.R STOEAGE— OTHER � p.Y.
GARAGE \ sq.R AtkicW[] DWadaed[] CARPORT N p.R Attrched[] Desaahed[]
MANU
FLFACTURED ROME INFORMATION: •e COPIES OF THE FLOOR PLAN REQUIRED'
MAKEA.F i..-kn dInrI M0DELCt �ca�_Lj_�.�,'V LI YEAR 2✓ LENGTH�ts'Sa
WIDTE1sl•f" BEDROOMS I BATHS SERIALNUMBER Z12 KIP 7112
ENVrRQNMENTAL HEALTH.
SEWAGESEWERSOURCE: SEPTIC SEWER❑ / NEW❑ E.XISTINGIff
PWMBiNGNSTRUCTUREI YES® NO[] IfM avach eompletd Wa Ad,g Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES[] NOff UISONGSQ.FT.
EKISTRNGBEDROOMS U PROPOSEDBEDROOMS I TOTALBEOROOMS 1
OWNER e:kroxYEpee NN wbmbfrond Inacwab wtlwmNMn may maYX In a sim wk oNua pemittnrwtiwl.GckmxbJ3emmlat aFX la b/
agrewn eaaa.l maven mar I am irK v...rer eae i mnnar beclwmm I am vamue�o ramrva ima awmn eae ro m mown u proFmeE.l nm
odalnae w^^Naro^m✓^au nw mcesaary wnlea.Ixualrg amye wd mMewwwmm mI n ne ac smu gent TnawbW W
reamaamams,iaa.vam men im Imom�m'aa X�uae'a acw,mla.�e ea.0 emoaraaa m uavoa cagy awvva m me abma eawnLm Pmgmb
am vmwXax•)rar mnvw Ww Imlwmmn mlv ceaaNawn�nan bvwmas men a wH Xwn or annom.a co.am,mm'�a am mmm.zm dwn ten
em.ermm�smxmn wx Ia aa.ceaeve tw a ceem a+eueaW.
PR FOF CONTINUATHINAF WORK ON THIS PERMO IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
IT APPLWO AYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
/ COUNTY CODE 14.08.42)
Sig d urrnI WNER Date
DEPAiTMUATAL REVIEW I APPROVED IDATE IUENED DATE I TAGSMOVF&COY, TITONS
BUB.DING DEPARTMENT
PLANNWGDEPAR[MENT
FIRE MARSFIAL
PUBLCHEALTH 1 13
PLN Approved
ov29/2024
Mason County Community Development
Gavin Scouter,
All Changes Subject to Approval
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