HomeMy WebLinkAboutBLD2024-00943 - BLD CD Environmental Health Review - 9/13/2024 MASON COUNTY PcrmitNo: L i9D -00M
COMMUNITY DEVELOPMERECEIVED
Permit Assistance Center,Building,Planning
BUILDING PERMIT APPLICATION AUG 2 3 4p%
PROPERTY OWNER INFORMATION: CONTRACTORINFORMATRYI:t AY Alder I Vim'
NAME:�Age taf NAMF:B&egffli aaon C r�
MAILING ADORE
SS:MTMSE ! MAILING ADDRESS:%W°�+an
CITY:Tame STATE:W ZIP Ill CITY:Pan()aa STATE:W ZIP:M3 SCO
PHONR#1:2sa- ITT j PHONE:--I--- CELL: m
PHONEN2:25a5(rr-Z357 EMAH,:PMI°pDbwgem.M.mm.— Z
EMAIL.eMXa A'MMS-� W REGfIBAr>GEEM1W EXP. 1 25
PRIMARY CONTACT: --- OWNER❑ WNTMmito OTHERS
NAME MP EIMIL PMNPQ4a!°areauvatlonmm O
MAILINGADDRESSKWEkkanO [ITV ruae.e SPATE We ZIPSMBr
PHONE--. CELL
PARCEL INFORMATION: .�
PARCEL NUMBER(12 Diga NemLe) ZONINO� 2
LEGAL DESCRIPTION(Abbroaud)f:aKra Lelm B]TRaB,e5Nat FIREDISTRICTNa MMen
SITEADDRESS=NERr I, CITYI-Wu r_-
DIRECTIONS TO SITE ADDRESS Emer hxe elm berae Mboye m,dBBlmodAm Waddw,HBon WIn.plaoe
WTHEPROIECf WRHEg2 "OFSLOPE(S)GREATERTHANI4%: YES[] BOB SNOWLOAD:_Paf
ISPROPERTYWITHINEOEFTOFTHEFOLLOWING: A'x..Aaimwoypyl:
SALTWATER❑ LAKEQ RIVF AREEK❑ POND❑ WETLAND[] SEASONALRUNOFF❑ STREAM❑
TYPE OF WORK: NEWQ ADDITION[] ALI'ERAI'ION❑ REPAIR OTHERQaNFUMamf
USEOFSTRUCTUREIAmWeae.ln�Cwm.n BW AeJ
1SUSE: PRIMARY[] SEASONAL[] NUMBER OF BEDROOMS NUMBER OF BATHROOMS_
HEATED STRUCRIRE? YES MO Mdu❑ YES IPMA»geyy Q NO❑
DESCRIBEWORK—ra`a-afandmo MISaymLLolm Gm
SOUARE FOOTAGE:Nm,nl
IST FLOOR sq.% 2ND FLOOR aq.ft. SRD FLOOR aq.ft. BASEMENT sq.ft
DWK K.R COVERED DECK_sq.ft. STORAGE sq.R OTHER sq.I
GAKAGE_sq.R AF.W[] De [] CARPORT It Anarhed[ DerxMd❑
MAMIFACTURED HOME INFORMATION: -4 COPIES OF THE FLOOR PLAN REQUIRED-
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIALNUMBER
ENVIRONMENTAL HEALTH:
SEWAGE)SEWER SOURCE: SEPTIC SEWER I HEWEI EXISTING❑
PLUMBING IN STRUCTURE? YES❑ NO S (f,,anoeh mmPTer dW a,,Aaf q ,Foem
PERIMETERIFOUNDATION DEANS PROPOSED? YES❑ NOD MWING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS TOTALBEDROOMS
s On Em lowid mihMaemissanw raa laiMp�mN MMIMW Wq MWerwpmlSMWdort Gtltlw.Ipwm leuNhb/
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aelmaw cem�a:lontmm e°me newssen wa� I�amBam aun�anl naearw was a Imw.R mpem'�ry mu wgea m.maw wql
an�o:ime rei.)iorre:emwa�e�wymra�BLmnp°�enowaopuouo.�°mmss��liiale rcewwlMoreew�e�eNa�:a�wm n�w�maan lm
a.n ore rmnnmemn.roa'i..�weaem mr.pa+oa w Im oars.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTMTY OF THIS
PERMITAPPLICATIONOFI DAYS 9ILYORIEWILL CAUSE THE APPLICATIONTO BE EXPIRED.(MASON
,O TYC I0.BBA2)
op 7/1212024
5 Bnah,re W WNER Date
DEPARTMENTALREVIEW APPROVED I DATE DENIED DATE I TAGSMOYESrOONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FlRE MARSHAL
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EH APPROVED
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