HomeMy WebLinkAboutBLD2024-00745 - BLD CD Environmental Health Review - 6/18/2024 Permit No: l/(�`�L`"{ ' �(�'1...�`�
MASON COUNTY RECEIVED
COMMUNITY DEVELOPMENT
P mnA Lt.ne« m<r,a.Ildlna Nmnln< JUN 18 2024
BUILDING PERMIT APPLICATION
PROPERTY OWNER
UNF'ORMATTON CONTRACT
NAME:TmADDRE NAME anymlmM n� G..
MAMR40 ADDRESS:trot u veb N tmt uma O
CITY:elwam STAIE:ram 21P;Q 8a � DRESS: STATE:.* y@:ae6x O t
PHONE 81:3e0aLo-tzn PHONE. CELL.:ll a o-un
PHONE R3: EMAH„new®tmneammmmum.mm
EMAII,:anyRtawlremnemebn.mn I.&S REG yxneaew3xa
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MAIL RE ING ADDSS CITY STATE
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PHONE CELL
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PARCEL INFORMATION, D Z
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PARCELNUMBER(13 Di®t NI®bv)31m63LmW1 ZONING
LEGALDESCRIPTION(AEbmviamd)n innewwwasmra11m1 FIRE DISTRICT = m
SITE ADDRESS 1130aevayd z
DIRECTIONS TO SITE ADDRESS a law Mm.*Ntabw 1SMn m d N
18 THE PROJECT WITHIN 300 FT OF SLOP r
E(S)GRGTIOl TDAN 14%: YES[] NO n SNOW LOAD:=.r
IS PROPERTY WITHIN 300 FT OFT ;POLIA)PPOpG: /a.amAmWPbI:
SALT WATER O LAKE❑ RIVERCREEK[] POND❑ WETLAND❑ SEASONAL RUNOFF❑ STRPAM[l
TYPE OF WORK: NEW E] ADDITION❑ ALTERATION❑ REPAIR O OTHER []
USE OF STRUCTURE(xmd.ee CmoSn c�..,WwwAag Ea,)elmN remOe raNxre
18USE: PRENARYE] SEASONAL[] NUMBEROFBEDROOMS3 NUMBER OF BATHROOMS
HEATED STRUCTURE? YES- -Buy❑ YES PWJ flW E] NO❑ —
DESCR®E WORKn SPRw 2Um d xW m WM Wmu as
SOUARKFOOT
1STFLOORM e0-ft 3NDFLOOR_q.ft 3RDFLOOR sq.A. BASEMENT_
DEIX_aq.R COVERED DEIXpSe q.R STORAGe eq.0. GUM q.R
GARAGEm a p,R Axached[] Demchai❑ CARPORT It Attached❑ Detached[]
MANUFACTURED HOME INFORAL1hTION: `I COPESS OF THE FLOOR PLAN REQUIRED-
MOD yRAR IJaU
TN BEDROOMS SATHS SERIALNUMBER
ENyIRONMENTAT HEALTH
sEWAGEISEWER SOURCE: SEPTIC E] SEWER❑ ) NEW13 EXISTING❑
PLUNIBINGINSTRUCTURE? ME) NO❑ 1Jy.,avaeh conrp/eted WatoAdegmry Form
PERNffiTERFOUNDATION DRAINS PROPOSED? YES E7 NO[] EQSTINGSQ.".
EXISTPIO HIH)ROOMS PROPOSED BEDROOMS 3 TOTAL BEDROOMS
OWNER adna.btlaesNmaudnlWon alnaaum:e Inlummbn mry rmun In a mW vmM aax cr permit mvcWon.AtlmaMedpememotauNr a by
abnmuro below.ltleaero mmlmue a.+ror WalnrmmraxNm w:iem emmearoromna uia cem�u endmtlp me rna ee pppWea.11wu aMelnetl Pann¢slan han ml Ne rwceaeerY Games.bMumW enreuemem nmau nr pernev N Imenul rageNlne mla Pryect Th awnW a:pal
TIEv nytivau :br rive&In Intormaaon Pmvlaea le eaamte end grams employe.M MUW Gun:ysczu Ie Me aEwe aewlbstl papery
() PWtlm. Tas permlVapPllmtlon becomes nulldvwtl Rxork oraWwdzed ccnaayyJcn gryR mmmenWtlwiWalm data a MmnepuNon xark b a..Metl to a period a1180 days,
PROOF OF COWINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTMTV OF THIS
PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 1608,43)
X 5/7/24
naWm NOWNER un I awlNe0 �- OSN
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGSRNOTFS/CONDITTON6
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH
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