HomeMy WebLinkAboutBLD2023-01140 - BLD CD Environmental Health Review - 9/21/2023 MASON COUNTY RllPer4&W mit 7 {�bb
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COMMUNITY DEVELOPMENT SEP 21 2023
PwmltAssl6mllrx 4 W,SWd1m.Mannlly
BUILDING PERMIT APPLICATION 615 W. Alder Street m
PROPERTY OWNER INFORMATION: CONTRACT OR INFORMATION:
NAME:N�&A RDpa NAME:44arauwwnP
MAH,WGADDRESS:05iSONmgown LIMA MAD,ING ADDRESS:462EG13.aieYlweYflnA
CTIY:E..ea STAM ZIP:_ CITY:W STATE:— ZIP.� m o
PHONE#1:W30P3RM1 PHONE;"M* laeT" CE,L: 02IWA em' > z
PRONE#i:(435Nii-Ta>Z EMAD,:N+AaY.M..e.YNAnsmn— q K
EMAH.: W REGN EXP. m
PRIMARY CONTACT: OWNER❑ CONTRACTORO OTHER z
NAME Mga EMAIL rxbaee®.a.emmlIX®Y.mn
MMUNGADDRE&S eMSOMntlYM .A CITY STATE WA ZIPROm D
PHONE CELL NaeHewe+ r
PARCEL INFORMATION:
PARCEL NUMBER(li DigN Nlm ) 31g1g.3P.IXI02g Z(INNORRS �1111
LEGALDESC U0N(Abbmvialed) LOTSOF6UR/EY1WIVAFe5Ie FIXEDESTRUCTFWM SEP 2 62023
STTEADDRESS SECry Wil kLwt GITY�+IY^
DIRECTIONS TO STTE ADDRESS RECEIVED
ES PRO]RCTWITIDNM0 OFSL(1PE(S)OREATERTBANI4%: YESD NOR] SNOWWADL—, d
Di PROPERTY W LAKE 00 FC OF THE FOLLO POM (CA WETI.AapPlyl:
SALTWATERD LAKE❑ RIVP.R/CREEKO POND❑ WETLAND❑ SEASONAL RUNOPP❑ STREAM❑
TYPE OF WORK: NEW 0 ADDITION❑ ALTERATION D REPAEI D OifIDt IT
USE OP STRUCTURE(neauer.Oda ro.nu spy,se.J Rea'gx.s
ISUSE: PRcmARYO SEASONAL❑ NUMBEROFBEDROOMS3 NUMBEROFEATHRCOMSi
HEATED STRUCTURE? YES(w AAW❑ YES l ,I eBW EJ NOD
DESCRIBE WORK
SOUARE FOOTAGE:/P..Po6eg
ISTFLOOR1515 p,R iNDFLOOR p.R 3RDFLOOR_,& BASEMENT p.ft
DWK_q.R COVEREDDEC _%�L,R STORAGE p.R OTHER q.&
OARAGE q.R Attached D Dwar D CARPORT q.R AW a[ Dem o
MANOFACTURED •4COPIESOF THR FLOOR PLAN REQUIRED-
MAKE MODEL
BEDROOMS BATHS SERML NUMBER
ENVIRONMENTAL HEALTH:
SEWAGFISEWER SOURCE: SEPTICO SEWER❑ / NFWD+ EXLSDNGD
PLUMBWG IN STRUCTURE? ma NO❑ lfy ,,,aW A ro,W WWatwAdgvary Fo.m
PERIMETERROUNDATION DRAINS PROPOSED? YES Di NOD MISTING SO,FT.
EXISTING BEDROOMS PROPOSEDBEDROOMS 3 TOTAL BEDROOMS 3
DWNER n:FmMBtlgs tlul subm'mun W inewveY IMpmOEan mey rmull in a ehpxpk oNelal Po�mn nroalbn.ecgvxYtlgemva y01p1 Yb/
elenemro eemw.l awn Inn 1 em me a.n.r ane 1 NrzrertleNan M.11 em emNe4 ro.eIXl.e ml6 Polmn amltl mw.en.Pr0M.1.1 nee
oS101rctl Poimlevm Imn eI11M10 n0[6560ry(ar5es.lntl Wisp erry ememeM�akbror gnie0 oI inlam9 mgeNlrq MY OIgOM. lbsa�n.IXYg01
eM ebuclurel611w revieweM IiePotian.Tlib matletl'n axunY eM grerfi wngoyms W MCOon Ccumyer�bNe eMve UuvIN'1 pgperty
grmNe0Wlc0tirn Mcamu null a rxM Ilwk a eutNaei wnYrucEm Y M wmmenW wMln 1p
dry0 m n¢n6WCanwM®euegeMetl fore Poretl u11E0 tlep.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF IN DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.0&4i)
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�Slgnaluro WOWNER(Moat ba slened bvaM1e DWNER) 4z3Dale
DEPARTMENTAL RENTEW APPROVED DATE DENIED DATE TACS/NOTF.SICONDTTONS
BUEDING DEPARTMENT
PLANNINGDEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH
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