HomeMy WebLinkAboutBLD2024-00372 - BLD CD Environmental Health Review - 3/29/2024 MASON COUNTY PeTmR Na:�� `h �01
COMMUNITY DEVELOPMENT RECEIVED
Permit Assistance Center,Bullefing,Planning MAR 2 9 202"
m
BUILDING PERMIT APPLICATION 615 w, Aid Strest Z
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:.#✓t0AI,1 E$`I'c/gJ NAME: m Z
MAILING ADDRESS: P%� MARSNG ADDRESS:
CFFY: She/A,w STATE: 1�v Ze: Vrsii,t CRY: ` STATE: ZIP:
PHONENI: _ Y PHONE: CELL: � 3
PHONE N2: 7c• 0205 EMAIL: m
EMAIL: y.. L&I REGB EXP.
PRIIfARYCONTACT, OWNER CONTBACTORQ OTHER[]
NAME. ES}'a�oA' EMAIL e,W��J . r
MAILING ADDRESS PG. 8+e .f-lV1J CITY STATE ZIP qA I<Rl
PHONE _JGa_Yn. 49�T CELL VILE
PARCEL INFORMATION: 9Fc,
PARCEL NUMBER(12 Digit Numlw)-42CUL 41_ y-0 «., - ZONING /Z F/p ,10j
LEGAL DESCRIPTION(Abbmv4d) T E�DISCRICf FQ
SITEADDRESS yL9 f
DIRELTIONSTOSITEADDRESSCn e.1 a 4nm P",_.. aa -fr.� o ClAA
a ,k Pa.,em.} g). L .t If, Cap.fool N.N -/- t CL ✓ 2rT✓
ISTRRPRWECCWITHM•300FTOFSLOPE(S)GREATERT 14%: YES0 NOjr SNOW LOABjL4-E AW -W,,B,
IS PROPRRTY WITHIN 200 FT OFTHE FOLLOWING: /CAarlollAnwyd):
SALTWATERO LAKE❑ M�ERACREIX❑ PONDO WIFTLANDO SEASONALRUNOFF❑ SCREAM❑
TYPE OF WORK: NEW Py ADDITION❑ ALTERATIUNQ REPAIR❑ GOIER TT
USE OF STItDCNRE(anmm,,,ce,q,,�a.,,.,w a14.[rc) �g1 '�(1/
IS USE: PRIMARYff SEASONAL[] NUMBER OF BEDROOMS NUMBER OF BATHROOMS_
HEATEDSTRUCTURE? YESrminawde$j M,S an/)eaAr[] NO[]
DESCRIBE WORK
SQUARE FOOTAGE:O ael
IST FLOOR&JO p.it 2ND FLOOR p.R 3RD FLOOR q.ft BASEMENT N.ft
DECK p.R COVEREDDECK_p.ft STORAGE q.ft OTHER p.&
GARAGE_p.R. Avachrd❑ DrfacW[I CARPORT p.ft. A.,c)d[3 DalacWL❑
MANUFACTURED HOME INFORMATION: r0 COPIES OF THE FLOOR PLAN REQUIRED-
MODEL YEAR 19 PI: LENGTH
WIDTH_2_k_BEDROOMS BATHS Z SERW.NUAffiER kBiI fA1HB r13II(r`
ENVIRONMENTAL HEALTH:
SEWAGE/SEWERSOURCE: SEPTIC% FEWER❑ / NEW❑ EXISTING❑
PLUMBINGINSTRUCTIU!Un YESX NO[] lyre.aaacF co,find WnloAdequary Form
PERIMETF.WPOUNDATION DRAMS PROPOSED? YES❑ NO$•_ EXISTINGSQFT.---EXISTING BEDROOMS PROPOSED BEDROOMS TOTALBEDROOMS�
DWNER 4nw.I dodre maubnlcmn ollna¢ur I knmermanon ost I am armed
ac, mm remalnd to dom mr,mr laamxnM monYOy
rre^awm noio.. araarr mat ure om,m me r�nnrr arnarr nrt i.m rmNea ro mcrrr�nre Frmin and m do u,r won ar FraWrM. no.a
owm.e�•ni::mnrvom.numn.oao..no.mr..'ce.a'cy rnv.a�n.m naaror con..m'imenai,ayammy m'e p•orea m.cwnar or maa
mOmm,otuma,mpm,,wmmms-,00n. ionwo.nl.en ioatmo mom,ar ompioyoeommoronco ednoarrmor snot oeormenoep rini
em arRmn(.)m.maewammeaaomn. a oftddpgiwma aaromea nuisvoa nwon or amrornra wnrimcom ra nog arnmen�e vermin teo
amor n oonmNCmn.arn Y roeoeie•e m a P.noa n teo eon.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.09.03)
X Bign rolO Mustb alaned MMa OWNER) - .2-42�e
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTESICONDITIONS
BUDDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH
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