HomeMy WebLinkAboutBLD2024-01359 - SWG Application / Design - 12/5/2023 PermR No: L p�35g
Aft MASON COUNTY fECEIVED ^
COMMUNITY DEVELOPMEN [�^
PannkGUNhntt QnM,SWUM Planning
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PRoeERTYowNERINFORBUI INFORMATION: PERMIT APPLIIC APPLICATION
2023 qFP fi� FSlpl� <
QONTRA
NAME: /Or71 F Z.AG/26 /J NAME: O
MAILING ADDRESS:3C 6 + SF eKD OLy/KC MAILING ADDRESS:
CITY: riLfFLTDN STATE:w�. ZIP:lii'—A4 CITY: STATE: ZIP: 7
PHONE#1: -c co PHONE: CELL:
PHONE#2: :_oE 7/5- tP.TL7. EMAIL: = m
EMAIL: L&I REG# ENP._/ /_ z
PRIMARY CONTACT: OWNER[I CONTRACTOR[I OTHER❑ —{
NAME 't Z :ZE N EMAIL D
MAIWNG((66DDRES 360 C(i] Z IV CITY /sv1 STATE ZIP`jam r'
PHONE j{�O_ 2.F. LOO CELL 7/
PARCEL INFORMATION:
PARCELNUMBERU2 Digit Npmber) ✓ 1 1(iV� I J O ZONING
LEGAL DESCRIPTION(Abbmviawl) FIRE DISTIVCT
SITEADDRESS 30yO 5r u[U eLYmAaT'c. H&y CITY Sh e/'fon l
DIRECTIONS TO 7qeADDRHSS
xd�¢hc en a 5 K/N arlT
ISTHEPROIECTWTTBINMMFTOFSLOPE(S)GREATERTHANINS:. YES[] NO[] SNOWLOAD:--,d
ISPROPERTYWFFHINMFFOFTHEFOLLOWBiG: :C arab :
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WEFIAND❑ SEASONAL RUNOFF❑ 'STREAM
TYPEOFWORK: NEWV ADDITION ALTERATION[] REPAIR[] OTHER []
USEOPSTRUCNRE(xn C a.,CwwnmeUy Dc)
IS USE: PRIMARY SEASONAL❑ NUM BEROF BEDROOMS T_ NUMBER OF BATHROOMS Z�
HEATED STRUCIURLT YES MA+'[Fr¢r[] YES(roa(JrfFrey❑ NO[]
DESCRIBE WKK��OO�TT EE G Ai 'T%p/v
AR (Pmiauel
1ST FL E00 .ft 2ND FLOOR��aa�sq.R 3RD PLOOR N.ft BAS p.ft
DWI _6q.ft COVEREDDEC&L z6q.ft STORAGE q.ft OTHER Eqft
GARAGE Eq.R. Aaachad[] Tk.&d[] CARPORT N.ft Afi e [] Detwi
MANUFACTURED HOME INFORMATION: aA COPIES OF THE FLOOR PLAN REQUIRED-
MAKE MODEL YEAR LENGTH
WIDTH BEDROOM BATHS SERIALNUIMBEK
ENVIRONMENTAL HEALTH:
SEWAGEISEWER SOURCE: SEPD SEWER[I / NEW[] EXISTING
PLUNUINGMSTRUCTURE? YES NO[] yyyyyy l4raa.aaaaAnomFleted WahrAdegaaa Form
PERIMETER/FOUNDATION DRAIN PROPOSED? YESA NO[] EXISTING SQ.FT.
EXISTING BED ROOMS PROPOSEDBEDR MS TOTAL BEDROOMS
bNXEP xAIVMxIOw met[Wml - Nma¢urab mlmnalvlmry�Wllna&op aexa Pome:mwwlim.A�nmeePoneMaleM laby
[gnmure Calgv.l eetlan ual l am ue wmx ana luny aetl[rt u[l l am enNl[e m�ecawtltia p51m11 ena m W uexwk a[pmpo[s].1 new
mwin[epxmu[ionage YIme re¢ss[ryon pmwea,sa0anyee[amera Mleararp[nka wsm n,ait, OWX ftl cTlaunpar In,
wmaents Wtl lire lnlmmnicapmvev la[tarele and 0lamaempl oyes[m wautou xmaSla nm ad .ncacpmpXy
and[W[:va([)for tnnaa and Idwnd.. Tma d,nd I IN ad n Oamn[6 nWl B wle A vak w aumonzee mrebuc9an i rwl mmmerva4 vANn 1B]
eay6IX H wnflNNOn xeM a EYspenOae Iw a peroe o!180 Iv,.
PROOF OF CONT UATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTMTY OF THIS
PERy.ff-�P ATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
I / r COUNTYCODEI<.OEAR)
,t/Ov.07.1025
nmre olOWNER(MualMtlened Wtl6e OWNERI Deb
DEPARTMENTALREVIEW APPROVED I DATE I DENIED DATE I TAGSTIOTES/CONDITIONS
BUILDINGDEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEU TH
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