HomeMy WebLinkAboutBLD2023-01530 - BLD CD Environmental Health Review - 12/22/2023 PermitN
MASON COUNTY
COMMUNITY DEVELOPMENT DEC 21 2023
Permit Aaatatenc<Canter,6uiNinclat omn 615 W. Alder Street
BUILDING PERMIT APPLICATION
PROPERTY OWNHR INFORMATION: CONTRACTOR RMAT ON:
NAME:eaeNlam" NAME'R'eN Blme OYmE owri A
MAILING ADDRESS:Po BoxtT� MAILING ADDRESS:Po BuxrsT' aJ
CTTy:Noaaepon STATEMA ZIP:2ml CITY:Heeeemn STATE:WA Z[P.011441 <; .
PHONE#I:meea.1 PHONE:Z�3ea.111 CELL:
PHONE#!: EMAD,:ahaKunh�^enm^'
EMAIL:melylaMNRPneLmm 1.21 KEG# EXP._ I
PRIMARY CONTACT: owlecB @ OONTB icwR❑ OTHER❑ Z E
NAME.— EMAOely
ILaeu ne®pm m artm
MADNGADDRESSPOBaXlW4 CITY eem°o°e SPATE WA zipsi B 0:4LI
PHONE man.m CELL 2
PARCRi ]INFORMATION:
PARCEL NUMBER U2Dipt Numbs)IPIIDSIA@ST ZONNO
LEGALDESCRBTION(Ab Aeled)6DT:AOFSPHBTPrtfV28SESWsurvEY91A0 PDtEDISTRICTH�pen n�
STTE ADDRPSSIO N Bmeen Aeon d CITYH^meven VAN'
DIltECTIONS TO SGE ADDRESS Ha 101 NOM,WeetN Wu OaNnenNl&R 1teB CaY MNa RBntte N6ackenfilmed. n
I6 THB PROIF.CT WCPBHN 3d0 PP OF HIAPE(s)GREATER THAN I4X: YESQ NOEI 6NOW Lo"It�
ISPROpERTYWTTBINIWFTOFTBAFOLLOWWG: (LSwFan Aaaappb9:
SALTWATER❑- LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ sEASONALRUNOFF❑ STREAM❑
TYPE OF WORK NEW @ ADDIION❑ ALTERATION❑ REPABT❑ GTHER ❑
USE OF sTRI)CNRE oan u4o+;e G•.w+IeYg.Be/N'ae Fee*FeeNnv
ISUSE: PRIMARY@ SEASONAL[] NUMBER OP BEDROOMS B NUMBEROFBAIFIROOMS R
DRATED 3TRULTURE4 YEs ornwamwl ws pa+Ta oDW 1J NO❑
DESCRIBE WOA%rs81 aglem fnaYgMtlory nama.
RR 1 Ay�TAGE:ca,P
1STPLOOR real .,ft 2ND FLOOA_N�ft 3RDFLOOR_gA BASPAIENT_m,ft.
DWX—al COV DECK 4aa Klft STORAGE p.ft OITER_a41t
GARAGE 11W agft AdmWEI Dnmhad❑ CARPORT ;,A Ammhd❑ Dnmwo
MANUFACTURED HOME]SFORMATION: •4 COPIES OF THE FLOOR PLAN REQUIRED-
MAKE MODEL YEAR LENGTH
1FmTH BEDROOMS BATHS SFRIALNUMBER
ENVIRONMEN7�A .HEALTH:
SEWAGP/SEWFR SOURCE: sFPTIC@ sEWBR❑ I NEW@ EXISTING❑
PLUMBAOIJ STRUCTURED YES@ NO❑ Ifyea,amah wepieted WwrAdrqumy Porn
PERAfETEWPOUNDATNNDRADISPROPOSEOY YEs❑ NOD BXISDNGSQ.FT.
EXISTNGBEDRWNM PROPOSEDBEDROOMS B TOTAL BEDROOMS 3
OYMER acaiWetlyasrMaubnKron N Iroxu2@ iMmmenon nmY:eautl in a Mp xaM ortMfer pa:ml:wmaYu.MYnvMenpemMllcf Wctl b IM
signature utterednetlPlee,hluuro Mn M1doamm all nthe noausan,Wen.
I(nucMWnn pd ac1 euMemm Ieannt a:b to pnNcCaMNMmbeme"PaMNampA O:eiM pmx)Mac asTle vemee1:n1Wlgwel repeaemee.+.eeprewmsineltne Nromiewh pw"sscunbarAammoempbyeeam Nnan County a¢eamNe a new mmehaIatt*M
e:q amif.larnmea -rua ,hal Tnm{nutmF0R4mMm lxmmea nunBwlanmMoreuNor¢eE construction is Mcwnmm[m w111M iB0
sYa ormmaameem V.aM aauapmdn nre Paean mteo ams.
PROOF OF46NTINUATION OF WO ON THIS PERMIT IS BY MEANS OF INSPECTION, INACTMTY OF THM
p ZONOF180 SOFMOR WILL CAUSE THE APPLICATION TO BE EXPIRED.(MeSON
CODE 14. 6 )
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DEPARTMENTAL REVTRW APPROVED DATE DENIED DATE TAGSaNdTESCONDtTIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH rI G
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