HomeMy WebLinkAboutBLD2024-00485 - BLD CD Environmental Health Review - 5/24/2024 MASON COUNTY Permit No: Bzj)i5z
COMMUNITY DEVELOPMENT `-
PermitAssistanceCenter, Building,Planning L �l�li rri
BUILDING PERMIT APPLICATION _ 6151'J. Aber P,traet z
PROPFRINOWNERINFORMATION CONTRACTOR INFORMATION
Ntin ��t1la at r ;� V, t NAME. n'I O
MAIL1vr aDDRTSt MAIl.ING ADDRESS: _— D Z
CITY'. STATEV,- ZIPS CITY_ STATE _ _Z➢'
PHONE n1 _ /, r _ PI10NE: CELL --�
PHONE ! c.L_l,-'i EMAIL. v
I MIDI 1 -h'� 1r, L: 1,'�c.L r.'a LIDREGN EXP_
PRIMARY CONTACT OW NER[2 CONTRACTOR❑ OTHER�]
NAME!Cvn T.X ITC �'t;; LLr EMAIL I to hsl IZ. L I
MAILINGADDRESS P D-K - CITY I3 STATE 1� ZI
PIIQN'E L - [$ 11 SCUT,
PARCEL INFORMATION
PARCEL NENIBEH(12 Digit Number) �Z��L �`T_ L �C_IG ZONING IF.GAI.DESCRIPTIONLAWI td) �] - L FIREDISTRICT ZS11EADDREEs_ `, '- I lh.nl F I1 clrYDIRECUONSTOSITEADDRESS � �? r, n. L i1,I Y1' t IS'IITFPRO.iF.CTWITHIN3N1 OFSLOPE(S)GREAIERTHAN14%: YESC NO9 SNOWLOAD
ISPROPERTYWITHIN300FTOFTHEFOLLOWING: fCMatmlmumpptylo
SALTNVATE1i LAKE❑ RWENCKEEK❑ POND❑ WETLAND I,] SEASONALRUNOFFE STREAM❑
TYPE OF WORK: NEW*_a ADDITION ALTERATION❑ REPAIR OTHER ❑
USE OF S I RUCTUKE(xe.;d.. iuswga Coww,,uRrkSL,[% r/&v /I f4oxidiiii, I_Iq'S�i
ISUSF_- PRIMARY SEASONAL[. NLMBEROFBEDRDOMS l NUMBEROFBAIHROOMS
HEATED STRUCTURE] YTS MTMa alegl Gi YEs ryoalrl fRw. NO[J
DFSCRIBEWORK it.
SOUARE FOOTAGE:
ISTFLOQ1 sq.0. 2NDFLOOR sq.it 3RDFLOOR it BASEMENT NA
DECK sq_ r COVERED DECK_ sq_R. STORAGE m,_ft OTHER__, it
GARAGE _sq ft Aaached L] Demchi CARPORT sq.f, Ammi El ➢with El
MAMIF((ACTURED HOME INFORMATION: `4 COPIES OF THE FLOOR PLAN REQUIRED"
MAKE_Ix"�L`r MODEL YEAR LENGTH
WRDTH "0 BEDROOMS -c-- BATHS SERIAL NUMBERS
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCP. SEPTIC} SEWER / NEW El EXISII-1i
PLUMBINGINSTRUCTURTI YESI NO /fyae,roach conplered N'me-Ade4aary Fosm
PERIMETER ouNDATION DRAINS PROPOSED? YES❑ NO$ EXISTING SQ.IT
EXISTING BEDROOMS O _ PROPOSED BEDROOMS OTAL BEDROOMS
GNNER adm,niew,1111 susure"nMlnaccurale lPwmerion ma/...Milo e4 wM1.....or preheat re"'w"."""".Egern.I o dwou is Ly
signature pelow.l Bound Nat l on we orrtrer ao0l Good,Eedare Mal I am a nted to receive INs permit and to did
Ne—r,we ppae d I rate
youlor ed pennistim hem all N i nemssary dow s.wer d'mp aM easement rattle m pare s of Inter or regarding this prowl me oswur or Eliot
raprown else,represents Thal Ne loom ate pmNded w aGv21e and Branls ertrioyMs of Mason Cmnry access N to e a M
M ahoy,d.—.d prope
and sCWre e us,reJew pe and instl r, This per nwappityl Mamas null null d w vm td I w or auNohxed mnsW ld"Is not mNmercld won 180
days w mmmerwron mrs is suspMded ter a Period of tea days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION 0F18 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
_ COUNTY CODE 14,08.42)
Signature of OWNER(Must besoned be the OWNER) Dale
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTEMCONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMF_4T
FIRE.MARSHAL
PLO ICHEALTId
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