HomeMy WebLinkAboutBLD2024-00714 - BLD CD Environmental Health Review - 6/13/2024 MASON COUNTY Permit No: 204—p71�
AEM COMMUNITY DEVELOPME 4 wr
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Permit AUlstance Center ` �, Building,Planning ' 2UL4
BUILDING PERMIT APPLICATION 615 v . .,Jet Stre�
PROPERTY OWNER INFORMATTON: CONTRACTOR INFORMATION: -<.
NAILJNQ AI)OREawlmmxk MAILING
ADDRESS:
MAILTN11dp, SS: STATE:NkalpppM MAiLAaften tm ea STATE:—
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PRONEf STATE:"? Z@:9MM CTTY:�I� STATLL �: Z
PHONE#1:ul:eroetet PHONE: CELL:seano-ta2
PHONE#2: EMAIL:I:RAa@ro,lmamn.mwrcan.mm
EMAE.: n� ®Imell.can L&I REG#NNe1MB13ke EXP.
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PRIMARY CONTACT: OWNER❑ CONTRACTOR EI OTHER❑ — Z
NAMEt"eep+e EMAIL tmval�loabeaamniWMb,.Can "'I
MAILINGADDRE01001eeampal CITY. SPATE=ZIPeB691 D
PHONE CELL r
PARCEL INFORMATION:
PARCELNUMBER(12N&it Number)229aS59-0996a ZONING'^
LF.GAL))F.S PITDN(Abbrevlamd) p ilipslak dal 90aIMMkl5dWp OO&M FIRE Dy4TRI�
SIZE ADDRESS�eINMq+e MuelmPN CITYenemn ✓�
DISECTIONS TO SITE ADDRESS nun her 3,gr�t op~,M,nnnpneips ake M. Rene 1101,Was lcop Medan,I mlapn 1,11 � �
n y
LST MOIECF�3Nn OFSLOPE(S)GREATERTBANI4%: ME] NOD SNOWLOAD:_paf
IS PROPERTY WITHDV 200 FP OF THE FOLLOWING: IClmctmsauapygJ: Q f
SALTWATER❑ LAKE Q ROISWREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW O ADDITION❑ ALTERATION❑ REPAIR❑ OTHER IT
USE OF STRUCTURE(Rmdm=c re..pa n--lald,,aK)reNae^N WraW
ISUSE: PRDMRYQ SEASONAL[] NIIMBEROFBEORMMS, NIIMREROPBATHROOMSI
HEATED STRUCTURE? )TS(aAaleakW❑ YES(Po Iv orDW 0 NO
DESCR®E WORK�LP�*^^+'ea,We
SQUARE FOOTAGE:tvr=saea9
1STFLOORI4 eq.ft 2ND PLOORIOM sq.R 31U)FLD0R K.ft. BASEMENT R.ft
DECKM rq.R COVERED DECK' ,.R STORAGE-7 ad.ft. OTHEE. R
OARAOE9M K.it Aaached El DetarAW❑ CARPORT eq.R AaaeAd❑ Detached
MANUFACTURED HOME INFORMATION: +4 COPIES OF THE FLOOR PLAN REQUIRED+
MAKE MODEL YEAR - LENGTH
WITH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SBWRR SOURCE: samcQ+ sEwER❑ / NEWQ. EXIsTINGO
PLUMBING IN STRUCTURE? YES 0 NO❑ 1/yW,arch domplaed Wdea Adeaaary Form
PERDdETER/FOUNDATION DRAINS PROPOSED? YEE 0 NOD EXISTING S(I.FT.
EXISTING BEDROOMS 0 PROPOSED BEDROOMS t TOTALBEDRMMSI
OWNER acknoeteapes h e suMnlsslm Of lneccunte Irkametkn raft MW M a mop wk Maw Po rent remamd on.Mkmwlsapemenl dsUN h by
M,slneaPo�,I deotard
men I mftmapeat,ItemenassWethat I am enNea to raceNs Nq penult and to do the w es pmpeeal.I lwe
Mam,e,represeMetneltne motmNon 9enreaand gntnaaer«peNaa Wlmw Cmm Mlrq Nla the ah ampatHhed pro l
mPreee apAamaeccumm and 9mma mnplermammeam ccunry eaev 1p me above tlacAbM prepay
end ebacwre(a)ra rcne«arm Inapecuon. ma I>mmluapplimum I,em,nx nua a vda rcnarx e.umalzea n9nawnlen a nm mnmeuea vmnin?ea
acre a npnmuclan eon a.uepmeea to a vedm M tad aaa.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVHY OF THIS
PERMIT APPLICATION OF 130 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08A2)
X 6/5/24
NOWNER NUM be started Mild,OWNER? Date
DEPARTMENTALREVIEW APPROVED DATE DENIED DATE TAGSINOTEWCONDITIONS
BUDDING DEPARTMENT
PLANNING DRPARTMEM
FRE MARSHAL
"tic HEALTH Q
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