HomeMy WebLinkAboutBLD2024-00408 - BLD CD Environmental Health Review - 4/1/2024 MASON COUNTY I'droutNo-
COMMUNITY DEVELOPMENT
Permit Assistance Center, Building,Planning
BUILDING PERMIT APPLICATION -
IPROPE.R�IjYOWNERINFORMATION iCONTRACTOR INFORMATION'
NAME 1 .70�f1 _Q �;� �{ _ NAME I EAII/F�_
MAILING ADDRESSTL'�W 'nia�bu PI DA4A[LiNG ADDRESS r-a-✓-I{'(U
CL'f:S Qc�iQ, STATEW/} ZI> O� CITY. _ STATE_ ZIP �MENTqL
P1iOM ] }t�0_�Zo olzz PHONE CELL - Tu
PI EMAIL 17
EMAIL � _;Ito/ 7m LCDM� LRI RFG9 TkP_ _ .-- __—
PRIMARYCONTAC7 owNt CONTRA EMA 0 ofxeR❑KATe_ ?IF—
NAME Se_ - { {�Lu�- YS EMAILMAILL _
CM-ST
PI10NE('ADDRESS
PIIOVF PFIL_ 9A
PAR CEL INFORMATION co L� ��. F D. Nr Myson PLO ��
P.V h®iCEt NtFR(12 Digit Number) 2'Z 310-LLL �/ W L ZONING 12^R-
1 CGAL DLSU2IPLION(AIL lea)rP 6(p fwr•v. RTA1 5P lk zI T5
SITE ADDRESS 7IlI—
nTRECI O�ISIOSIfE.4I)DRESS_01d�a,If�i� u ..
3 I Lh. 7'S
ISTIIFPROIFCI \\'ITHIN300FPOFSLOIE(I)CIMA'PERTRATIA%: YES[] N01Z SNOWLOAD:2—r Fr S'
IS PROPERTY IVII HIN 200 FT OF THE FOLLOWING: (ch z Irhomnvbb
SALi\\ 1TFRQ LAKE RIVERrCREEk(] PONDS V,EII SEASONAL RLrNOFFC] STREAM❑ i
TYPE OF WORK NEW K ADDITION❑ ALTERATION REPAIR OTHER (] I
ICSEOFS'TRUCTLRiE(Rnuv,ioo,,,.,corom':minlag.em)_7z-�T l '4'
IS USE: PfLnIARY&Sp SEASONAL NuAf i OF BEDROOMS 3 DIMMER OF B iTI1ROOMS Z
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FIDK!-eP SIRCLTU-R}E? 1ESS01, se, lESO nbpofempl❑ NO� 1
Imo SOLI
=- u�� 1V-✓__t�_R 4R-I�u.F-EGfl. RASF,ntE\f _s4.ft. J
DESCRIBE EORK ♦
SODAREFOOTAGE
1 S'1'FLOOR 14 I I{ ft 2VD FLOOR
DECKOO sq.D. COVEREDDLCK_— rq.ff. STORAGE_ —PSfti OTHER sq.O.
GARAGE _aq.fl_Armohod0 DemJred❑ CARPORT_ 11,f. AttoeAed❑ Demrched[]
MANUFACTURED HOME INFORMATION: -4 COPIES OF'TRE FLOOR PLAN REQUIRED^
1LAKE_�(,y`/�D rfODEL�$'�Ii S+s In RP YEAR 2-02
lW
T _t LENOTH sC0 _
\F IDTH ZT_ BEDA00>1S_. / _ D.KIHS `Z-_ SF_'RIAL RG\IDER/eLIS>♦J YLB3y 0_
ENVIRONMENTAL HEAL'TPr
SEWAG CERfERSOIIRCE. SEPTIC SE\CLR NEW EXISTING(]
PLLFffiING IN STRUCTGRE? YES0, NO Q If,, DaachccompN"d INN'Adeguac..Fonn
I PERIMEfECFOL NDAfIOR DR 4INS PROPOSED? YES(] Doi EXISTING SQ.Dr.
EXISTING BGUROONIS PROPOSEDHEDROOMS 7j �O ALAIDROON ✓�
OWNER acknowfedge5 that remesslon of ofecu2m infommlan may ii In a are,Volk Decal or,rermh revooalma ACBnoWed,menlol s om a Oy
Alslgnattreb:nw ldLlarethall SmtheownarandifuMe,declamtlallamentNledareaeHWspannilan01odoteempkaspmp,W has '
i oblaNaticem+Issan tram all the nere55ary 1apia5,Indamna say easement holder or partas of tressed Fresh,this Arne, Tes.,irefegal I
ar,reseraantlsW Nre(s)fo'mrnhIe ifol antl the informal
nfo^etiT^pmvldedaace,rale and grants employees of Meow Oounty-cress to the awe tlamnbah plool
pa,,Vappl-tloo cewmn nml a void If woh orauaDdzea w.tmaon:s not commenced Kllbm IED
nays or n coosWdlon seek is 5uscended fora pe,.of e0 days.
PROOF OF CONTINUATION OF WORK ON R PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF 180 DAYS OF MORE WILL CADRE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14,08.42)
Ignaa Meof DWNER IM1tuet be Slenetl Ev the OWNER --7/ / ale�—
DEPARTMENTAL RENTER' APPRONEll DATE DENTED DATE TAGSrsOTE&CONDITIONS
AI ILDLNO DEPARI NIENT
PLA\'NTNG DEPARTMENT
FIRE MARSRAL
❑CBLICHEALTH ^�
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