HomeMy WebLinkAboutBLD2024-00192 - BLD CD Environmental Health Review - 2/13/2024 MASON COUNTY
COMMUNITY DEVELOPMENT FEB 13 2024
Permit ASSlstance hn[tt,EO11dIMPlannin
BUILDING PERMIT APPLICA-66k W. Alder Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:Rw.la rrevm NAMEGiesec coon samma(Nuom Gme Pensd wna.dw) O
MA]I.ING ADDRESS:vo sonassz MAILINGADDRBSS:POm 43n
CTTY:Senalr STATE:— ZIP; 22 CITY:soon cap STATRVWA ZIP:MM4
PHONENU?M2n081n PHONE: CELL: 2M' '1 5
PHONE I2:42seSt.sats tan P--noun EMAIL,:YNeawneaadg..lsa--@ ^^sna"' m
EMAR.:mrarBtmaome.mm L&I REGNOIESEcae21CF HIE._/_/_ z
PRIMARY CONTACT: OWNER CONTRACTOR OTHER❑
NAME"...ram. ENAIL n^0mimak— y
MAULING ADDRESS FO som Msz CITY eeNe STATE WA 2I,SK4!8 r
PHONE a sma snm
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Numbs)222 Ma Iao WNMGRRs
LEGAL DESCM ON(Abbrewfed)TR 19 a Gand Ld 3 Bn3G1 FILE DISTRICTN—Masn"
STTE ADDRESSM0 NE Nanhstlma%a l CRYIwaInr
DIRECTIONS TO SITE ADDRESS 69 mW main seM:r on SR=(tans nn Nwn Nam Roma).site rem East We of mad imwnemry
I»st CeaV LreaY.
18T PROJECTWM"30EFTOFSL MCS)GREATER'IHAN14%: ME NO[] SNOWLOAD:�mB
IS PBOPERTY WRBDV 2AIO FTOF TBE FOLIAWRNG: (aadkdlsaad y)!
SALTWATER❑ LAEE❑ RIVER/CREEK 0 POND❑ WETLAND O SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW Oi ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCNRE(A Mms.Gwye.C_mda, N m)Resclance
ISUSE: PRIMARYD SEASONAL❑ NUMBER OF BEDROOMS 4 NUNIBEROFBATHROOMS 4.6
,,,,,,STRUCTURE? YES(w ewe❑ YES�,/ado&W EI NO❑
DESCRIBE WORK Nwmnetmctlom aalripetemy mdemm
SQUARE FOOTAGE:(omPoreG
IST FIDOR 1sn q.R. 1,D FLOOR 2121 q.d 3RD FLO YR q.R BASEMENT q.R
DECK_q.R COVERED DECK 1a2a q.R. STORAGE q.& GTHER q.ft
GARAGE'P" q.R. A-m ddQ Deldcad❑ CARPORT_q.R Amishad❑ DemaAal❑
MANUFACTURED HOME INFORMATION: e4 COPIES OF THE FLOOR PLAN REQUIRED•
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIALNIIMBER
ENVIRONMENTAL HEALTH:
SEWAGFISEWER SOURCE: SE?nC O' SEWER❑ / NEWS EXISTING❑
PLUMBING IN STRUCTURE? YES Oi NO❑ /JYs1,amch wmp(eted Water Adegwpy Form
PEREAMR/FOUNDAnON DRAINS PROPOSED? YES O NOO E%LSTING SQ.FT.0
EXISTING BEDROOMS NA PROPOSEDBEDROOMS 4 TOTALBEDROOMS 4
OV/NER ac .,es ftl mammam,ot'sm.nmeinlwmmiw may result in a--I—waer w pmmit mnonason.M ten md9emae d susn Iaq
N9roturt LWW,t ayem MN I am tM comer and I weer aecbm net I am entitled to r me Reis same and io ao the v as m,sand )have
oaw aM pennismm fram aii ma necesmrr pam,including any easement hod.,ommm d mlmmd ra,mmn,.prgetl The—Iepel
rearasa mws)f—ma1MImm Mmne1M pmNaea i6 eDYmeens pans-emolyte-N Meson eWnly acGmsmme.aoK deawtiaa ymNy
eMaWcture(s)tw Ww end Ius dW O pmmdapplbaGm[emmm nJ11awenwYk weuuCe=ee mlaXucnwbna cwnmMCB]VMhm MO
-era wn owgtmdm.smM is sueaendd ter a aeeod d 1Ss aan.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT 15 BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
Z- 13 2 y
SpneEea W OWNEI(Muat Is,signed be ow OWNER) Data
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGSMOTF4/CONDIRONS
BUDDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
Pi1BUC HEALTH III
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