HomeMy WebLinkAboutCOM2023-00096 - COM CD Environmental Health Review - 10/17/2023 f MASON COUNTY COMMUNITY SERVICES Permit NoO.Zff $i1Zr 0
PERNR ASSIS FANCE CENTER:
•aUlf➢ING.PIRNNING•pUEUC HER .ERE MFRSNAL
aI5W.NX-SGbt5l,etleeWA945Xe OCT 16 2023
proms aadin,(3a0)eST-0Xr0u 3U•P (3e0)427-nee pbm
11 Y ..(350)3)5iea].Phdne Elme:(310)19A518p
615 W. Alder Street
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: NAME:
MAIL G -gRess: ADDRESS
c[TY: :
STATE: ZB: CRY:Y: STATE:_ZIP: �LT
PHONE41: PHONE: CELL: TLRM
PHONE#2: EMay.
EMAIL: [.1�G# EXP._7_/_ OC T 1 7 2023 _
PRIMARY CONTACT: OWNER CONTRACTOR❑ oTBER❑ RECEIVED
R� 1� EMML
NAILING=S OTT STATB_ZIP—
PHONE CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 4 I2-ro- J(oQ5ZONING
IEGALDEICRIPT[ON( b iem1dfl' RRE.WTNCT
STTEADDRESS J1 Q 0 CITY I.fa2"1
DIRECTORS TO SITE ADDRESS 4
LSTRRPRO]ECFWTrtIN'30DFFOFSLOPE(S)GREATERTRAN14%: YES.❑ NOD SNOWLOAD:_Pd
IS PROPERTY WITHIN 2EE FT OFTHE FOLLOWING: ICbnlai� .
SALTWATER❑ LAKE❑ RrvER/CREEK❑ POND❑ WETLAND❑ SEASONALRUNOFF❑ STREAM❑
TYPE OF WORK: NEW❑ ADDITION❑ A�yg(M_noNx REPAIFR-❑ orUB R D
USE OF STRUCNRE(Renbe[.Gan •CanunuvenaNAF LIL5%64 ' T
IS USE: PRIMARY SEASONAL NUMBER OF BEDROOMS NUMBER OF BATHROOMS_
HEATED STRUCTURE? YES(NxNe an¢n❑ YES Man/.)Nemp)❑ NO❑
DESCRIBE WORK
SOUARE FOOTAGE:o.,-at
ISTFLODR_N.f- 2NDFLDOR_K.R SRDFLOOR egIR BASENENT_p.R
DECK_eq.ft COVEREDDEIX sq.ft STORAGE N.ft OTHER_sq.ft
GA OE_N.RAnarJmd❑ DemcAed❑ CARPORT pq.R AveElred❑ Dedehed❑
MANUFACTURED HOME INFORMATION: '4 COPIES OF THE FLOOR PLAN REQUIRED'
MAKE MODEL YEAR LENGTH
W TH BEDROOMS BATHS SERIALNUMBER
ENVfRONMENTALHEALTH: `/
SEWAGFISEWER SOURCE: SEPT[ SEWER❑ / HE� EXISTING❑
PLUMBING IN STRUCTURE? YES NOD zfP -an.'A �aPbmd WmerAdgwWFo.m
PER1h1ETER/FOUNDATION DRAIN PROPOSED? YES❑ NOD EXISTING SQ,FT.
EXISTINGBEDROOMS PROPOSEDBEDROOMS TOTAL BEDROOMS
OXNER VWWaCpe[delsuGn"-Wb....aaj-mH Henn be awvwk>Cmnr Penn,na b biwuda,pemmed alM YW
YpmWn[abw.l btlw tlW I em tl2 omwrem I NMxOetlwtlu,I em nObE b ramhXnc pemil eM to d>tlnw+h[[POMeW.I M1n+
aLbineX pnNUlm Gun ell tls mmcsery mNe[,Ntlu3�q enY e+[emem edEm or peNe[M FtereY�WeIMp tlis Wnb�Tlie wniawMpY
Iepeee+tlX .nPreaw[and aeon ne,wn5 Wmn,emven panul[& oyee[mMnan Ccumr eecez[,ton mauab[encedaapeM
eN eNrlue([I Mnxw' . waanded TIAe yda Hof I llyda a.Eecnres null s wiE X wA u auMomeE mmWctlon u nd mnmencetl xMin IN
Ory[u tl roneYu2onwA Y alupeMeEb!a pent N IBO Eye.
PROOF OF CONTINUATION OF WORN ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPUCATION OF IN DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE K08.42) lOe II'ee�
s
ff"01 ER M n theOWN R Del'
AL REVMW APPROVED DATE DENIEDDATE SAGSINOTES/CONDTHONS
ARTh(ErTTARTMENTH
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