HomeMy WebLinkAboutBLD2024-00521 - BLD CD Environmental Health Review - 3/14/2024 Permit No:V� � � I
MASON COUNTY RECEIVED
COMMUNITY DEVELOPMENT
Permit Asnstance Center,Buneine Namin, MAR 142024 -
BUILDING PERMIT APPLICATION glfilN A' t
PROPERTY OWNER INFORMATION: CONTRACTOR INFoi TIOM:
NAME:�Wnr1L1164L 6ReB�5 NAME:ASIHSV�f{cAaES IN[.
MALLNG ADDRESS B 2W'L- MAADDRESS: Dnsil
CTN: eI ST TE WA ZIP: CITY: �1GP..�L7711 ff11 STATE:WD ZIP:
PHONE#7� PHONE: W 09 0 CELL: frn
PHONE x2: EMAIL' HI asW'e "^e"-�°"^ D Z
EMAIL: L&I REG xa#K 11j6' RMI rII EXP. / /� r
PRIMARY INTACT: OWNER❑ CONTRACTORM OTHERD m
NAME e, uY1uGOai 1NFa2MTH�1 AtSOV@MAIL
MAILINGADDRESS CITY—STATE—ZIP z
PHONE CELL D
PARCEL INFORMATION:
PARCELNIIMBER(I2 Digit Numbm) 2-7-101-S0-00636 ZONING
IEGALDESCRIPMON(AbMcvirt )MLLoN Luca BSTAYES TIL 21. FIRE DISTRICT
SUE ADDRESS 20 @ ILA"--ALAI' D12 CITY ��
DIRF.CI'IONS TO SO'EADDAES31 'S T Mesrna2 Llt-RA. LL. 0N},e AwN LItE Rp,
R06Nf O,m E MASMN DR S SITE ti N L.R1PF
ISTHEPROIELTWITHOV30UFPOFSWPE(S)GREATERTHAN14Ya: YESD NOR�-SNOWWAD`tnf
ISPROPERTYWITHIN200FTOFTBEFOLLOWING: (cx.d.BJvgy.Yl:
SALTWATER❑ LASE RIVER/CREER D POND❑ WSILAND D SEASONAL RU IM D STREAM❑
TYPE OF WORK.. NEW ADDITION❑ ALTERATION❑ REPAUL D OTHER D
USE OF STRUCTURE(e..rnism C.ge.[mrwmblWg b) �'�
ISUSE: PRIMARY& SEASONAL❑ NUMBFXOFBEDROOMS 3 NUA4HEROFBATRROOMS
HEATED STItUCTURET Yffi(NtiaAAML YES1�eNy❑ NO
DESCRIBE WORK TS V 1I-0 N OSO K] SGiL
U RRN Aye.E FOOTAGE:
ISTPLqOO�R� �2I.a�,. eq.& 2ND FLOOR l30� q.ft 3RDFLOOR_K.A. BASEMENT eq.A
DECK_I—I_aq.O COVESEDDECK U& q.fl. STORAGE eq.fl O'IUER_q.R
GARAGE eq.R Anached M DOac 0 CARPORT NSA ANacAed❑ De ssf[]
MANUFACTURED HOME INFORMATION: e4 COPIES OF THE FLOOR PLAN REQUIRED'
MAKE MODEL YEAR LENGTH
WEJTH BEDROOMS BATRS SERIALNUMBER
ENVIRONMENTAL HEALTH:
SEWAGVEEWER SOURCE: SEPTIC SEWER❑ / NEWS. MST04G❑
PLUMBNGMSTRUCTUNET MEL NOD [lyv,anacA cmplaed Wara Axegwry Form
PF.RIME ER/FOUNDA ION DRAINS PHOTOSEDT Y63� NOD 103S [NGSQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS TOTALBEDROOMS
owxE2 ecbmteeOeetlW eWnWmr/Ine¢eete lntwmanm meY maul�InacYp wakaNmar Pemm muwetimr.Atlmowleege NacM14bY
,ems,.:
na mmr.mmeomrarmni roudraaeare re em araaoerpsi,of
mitepeon arum eo tswwm oop«a. save
oewroatwin, lonrem ain ineceueysir, leeuis ag ary mrseaard rants
ns emor —a or... regmeiny Ilesp a ab This w.neror ie0ai
repruemaivx,mmoaems urm ve mlormmim noanan is wren are Bmma ememvaasw Nte:er cmmy awassm ma aoo.a xsoncea popery
ero seueNeelal Ip review am inapmtim.mM y mivaopiranor�nmea r:,n a.oa m„.,n o,aumovze mrmaumn is rim wmmancea.mmm tro
epa m ewnawcnon wA re wspennea nra paoE a tao eaya.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF 100 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODEI4.OBA3) �5// 4
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DEPARTMENTAL REVIEW APPROVED DATE DENIED DATB TACS/No acirmi DYPIONS
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