HomeMy WebLinkAboutBLD2024-00688 - BLD CD Environmental Health Review - 6/6/2024 MASON COUNTY PelnitNN•A U9,10A O*B
COMMUNITY DEVELOPMENT -E C E I V E D
Permit Assistance Center,Building,Planning JUN — 4 2024
BUILDING PERMIT APPLICATION 61 A W Alde , Street
PROPERTY OWNER INFORMATION: CONTRACTOR VOURMATION:
NAME;RM&RILL NtLKKA40N NAME:
MAILINGADDRRSS:P.0EOR21e6 MAE.INOADDRESS: rn
CITY:SELFNR STATE:B'A ZIP:98US CITY: STATE: ZIP: Z
PHONE01 Mwi1 S/ PHONE: C13LL: L
PHONE i{2:Ma aplasm EMAIL:
EMAM:R01EMIa/gnn01.c0M LET REGA / = 0
PRIMARY CONTACT: OWNERB CONITIARORD OTREII[] 1D
NAME NNit1N[a8Qa EMAIL RDUEN M
MAIWNGAODRRA P.C.110XEtB0 OTTe — STATE WA ZI PHONE CELL spasm ®vtar
PARCEL MFORMATION:
PARCEL NUMBER(12 DigitNiaaber)12a21a49We2 ZONING RA D
LEGAL DESCRIPTION IAbDceviucd)LOn OF siwtvAFr2tlKb aIROF SE Mw FIRB DISTRICf0NT2 r
SITE ADDRESSNACHEMLK TARE CTTVMNYMR
DIRECTIONS TO STIE ADDRESS a'^'°munrwbtmurrx,rwwweoawawo...m
IS TILE PROJECT WITMIN 3W FT OF SLOPE(5)GREATER THAN II%: YES[] NOB SNOW IAAD;_Psf
TSPROPERTYWTIRIRM"OFTREFOLLOWINC: (a. Wzdaash*):
SALTWATER[] LAKE❑ R1VER/CREEK[] POND❑ WETLAND[] SEASONALRUNOFF❑ STREAM[]
TYPE OF WORE: NEW B ADDITION[] ALTERATION[] BEPADL D OTHER n
USE OF$TRUCTORE(MNw'a.G,qr.Cwwev+al BW Fc)SMIE FAMILY RESMENCE
ISUSE PRD/ARYB SEASONAL❑ NUMBER OFB R MSI NUMBER OF BATHROOMSZ5
REATED STRUCTURE? YES~,-w El Y&4 rA+Y i-fZ,NO[]
DESCRIBE WORK
ROUARE FOOTAGE:&-poaao
WISTFLOORI eq.R 2NDFLOORI4 eq.L 3RDFLOOR sq.R. BASEMENT eq.R
D sq.& COVEREDDECK p.R. STORAOB q.R OTHER sq.R
GARAGE'& sq.R Asmchd0 D W13 CARPORT sq.R ABadd[] ➢arched❑
MANUFACTURED HOME TNFORMATTON: '/COPIES OF THE FLOOR PLAN REQUIRED'
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWERSOURCE: SEPTICO SEWER❑ / NEWB EXISTING[I
PLUMBINOIN STRUCTURE? YES O NO❑ 1JTB.and h mVIe d W4WAdeq yFarw
PERA�UNDATION DRAWS PROPOSED? YESX NOB EXISTING n FT.
EXISTINh3DMRO0MS PROPOS®BPOROOMSI TOTALBEDROOMSI
M EReWvaetl0�Neta[m'usimtlMevumb INmntllon meY m�uXIn a&ap✓A wOerw PamMmttetlm.RrA,xleE6ameM MswM1 Lv ey
sYJ,mNe Ltlox. badfre tlW Iamtlre ewereM NMa hclere Rn ame,Y1tla0 b,nerve N'k psmYlaM to do ticvoM as p,eposN.I have
Ipaeul peem�wfRaa el Xy asmery paryp,IMUSn9 eery ec>emant MYArwpeNN MiMamsl reaaNl,g tivs proled. TIa nwm,orlryel
mlarsw,dlYva.eepeem[e Twtle FfaemYbn pwNa!k asaate aM graMa anRoYaaaal Mawn CeurM1y e¢ew b Xre aheva OasorCw peepaty
tq aNnNela)N2Aew W Yispetllws lHs psemNagYMatian Ncwres null B rHE Xuwk w aaM�lzetl wnswckan k rcf axrthenaW wltNn 1 W
tleyc wX¢nspUd41 evt MauepMlaeemre IMnoa N 1tm aeya.
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
CWNTY CODE 11.06.12)
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E elljRbfOWNER IIIua1MBlRtrtl Wtlte OWNERI � le
'DEPARTMENTAL REVIEW APPROVED I DATE DENIED DATE TAGSMOTEE/CONDITIONS
BUI.DWODEPARTMBNT
PLANNING DEPARTMENT
FlltE MARSBAL
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