HomeMy WebLinkAboutBLD2024-00331 - BLD CD Environmental Health Review - 3/18/2024 iObIL MASON COW NTY COMMUNITY SERVICES Permit No:b
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PERMIT ASSISTANCE CENTER: R E C E I �A
•6VILOlNG•%ANNM/G.F4SlIC HEALTH•FIRE bAR3HRL !/
8( W NMr Sbwt SMXon. 88681
Peorn SMlke:(]BO)IlIi8T0flr135Y•Fex'(380JI]T->IpB FYwrn MAR 11 2024 �
9YIx'r(]90J3TSdbT•fygM Elmo:(360JI933M8
BUILDING PERMIT APPLICAAlcipr �02
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: O Y1 NAME:
MAIL S: E INC,AnnRRsS; Y /i
CITY: STAT ZW: TTY .�
PHONE#1: 1'Ie � PHONI: ICELL:
PHONE#2: - EMAIL:-
EMAIL:
• L&.I REO# EXP._/_/_
PRIMARY CONTA •M1h1 OWNER LONTUCTOR❑ OTHER[I
EMAIL
MAIUPHONE GADD SS CITY STATB ZIP
PHONE CELL
PARCEL INFORMATION: MAR 8 COZ4
PARCEL NIIMBER(12 Digit Number) y2123 - 31- 00000 ZONING RECEIV
LEGAL DESCRIPT,.IIO-N..(AArbbreviateA) FIREDISTRIC�� ED
SITE ADDRESS�LIy, MIC IL CRY
DIRECTIONS i0 SITE ADDRESS
IS THEMMECFWPI M3Wff OFSWPE(S)GRMTERTHANI4%: YESQ NOXSNOWLOAD:_pA
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: rtha3 mlrb roPhl: BBF{{4
SALTWATER❑ LAKE❑ RI.VtER/CREEK❑ POND❑ WETLAND❑ EA L SSONA RUNOFF❑ STREAM❑
TYPE OF WORK: NEW OB ADDITION❑ ALTERATION❑ REPAM 0 OTTER n
USE OF STRUM"(m .rur .cwmvm A*,,Sec) GAI!foy
MUSE: PRIMARY❑ SEASONAL[] NUMBER OF BEDROOMS_NUMBEROFBATHROOMS—L—
LIFATED STRUCITIREP YEs I akw YES/pwe/yoreuy❑ NO❑
DESCRIBE WORK T
SOUARE FOOTAGE•YewmeaD
IST FLOOR O sq.ft 2NDFLOOR eoft 3RDFLOOR_sq.R BASEMENT—soft
ft
DECK_sq.ft, COVEREDDECK_K,It STORAGE N.ft OTHER q,R
UGE' GAsq.ft. douched() DemcAW❑ CARPORT sq.ft Anrc#dD DemchedD
MANUFACTURED HOME INFORMATION: eO COPIES OF THE FLOOR PLAN REQUIRED•
MAKE MODEL. YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAOF/SEWER SOURCE: sEPUC'A SEWER❑ / EXISTING❑
PLUMBA'GMSTRUCilIRE1 YFSry NO[I Ijyea,oax led0ohrAdeguory Fprm
PEJUMETERM)UNDATION D SPROPOSEDI YES N ❑ EXISTING SQ.FT.
EMsm BEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS
ONxER xkrwMetivea Mae auhnkslm arineOwtle InMmYbn mw readl m a NgroM1«Om n yrNl eewmlbn.MboMe6Jemme m euM I.ny
,lelalnea pe-l15s,an M10 all thee—earypaees iaele,npey easmment haN w G.Nes M1nllepemrerxarymao yoe e Th-ee.11wva
revNe ma pege'mv u Ina«w.r«level
rgresentati.e,represems lFvl Ne iMom.etion pmvMep is acmeale mG peenu employees W Hawn Courtly a®es b Ne Snow tlewlEe]gopalty
p ahucruee(q(a eerlwr antl Inepectlon.Tnla grmNergfration�mme5 nW18 wl8 XxM or auNonxetl m'ehuctlon b nd mmmerceE x1Nin tBD
E6yi of XmnaW[dm enk is suSpeuGeE M1wa penoE o1180 Eeys,
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVRY OF THIS
PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14,08.42)
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Mar-m II , Z07+
SlBnemn a(OWNER(MeutbalpnatlMMe OWNER) pale
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAG!g(N TES/CONDTTIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC FffALTN 10
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