HomeMy WebLinkAboutBLD2024-01111 - BLD CD Environmental Health Review MASON COUNTY
COMMUNITY DEVELOPMENT RECEIVED
Pend[A¢laanm taller,BWMInr,Namiing SEP 13 2024
BUILDING PERMIT APPLICATION
PROPERTYOW'NER INFORMATION: CONTRACTOR INFORMATION, 615 w Sb6Ef
NAILING D NAMINGADDR W
MAILING MAB,DiGADDRESs:,, WA eSFP
CRy;eum STA'fP: Z1P.�t PHONE Mw STAT'LL: 9P:�ie
PNorsaL EMAIL:w�,ee CELL: RFC �1016
gB,: �Yn9il.n«llrmal
EHONEMAIL: : — LA1 REG�Hl1NN'189J! EXP.�__ F
PRIMARY CONTACT: OWNERO CONTRA�aRE] 0
NAME r' CDY ar STAI'e M!ZIPMrot
MAILMGAODREESw4 IX LBLL aN,no
PHONE^°m'°r
PARCFLINFORMATION:
PARCEL NUMBER(12 Digit Number)99mSTNo,� i'
LEGAL DESCRIYOON(A ..Wi) FIRE IH DIg
TRICf
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SITE ADDRESSYt NE B«mak9a IX.BMbkwA 9lEU CITY��
DIRECTIONS TO SH7 ADDRESS
IS THR P,O CrWfTHBY 300 FT OF SLOPE(S)GREATERTHAN I/%: ME NO❑ SNGWWAD'�r
IS PROPERTY WITHIN 2W FT OF THE FOLLOWING: (u raua apm! SEASONALRUNOFP❑ STREAMO
SALTWATER13 LAKE❑ RiVF,R/CREER❑ POND❑ WETLAND
TYPE OF WORK: NEWS ADOMONO ALTERATION❑ REPAIRO GTHERn—
MUOPSTRUCTUREl SFAS. NAL�cla¢wnd NUL�ROFRE
MUSE: PRIMARY❑ SEASONAL❑ NUMBER OF BEDROOMS?NUMBER OF BATIIROOMSO
HEATEDSTRUCTIRtE1 YESNnd B YL'SY>'anpldRled❑ NO❑
DESCRIBE WORK
COGARE FOOTAGE:N�
IETFIODRtjgeM-ft 2NDFLOOR_N ft, 3RDFLOOR aq.R BASEOffiN'C__N.ft
DBCK_ N.& COVEREDDECK—OX25—RA STORAGE ak OTHER N.ft
GARAGE_c5AL W.ft Auached O Oemc n CARPORT q.ft Olac3ad❑ DetacFM❑
'MYACTOM HOME INFORMATION: '1CO➢IES OF THE FLOOR PLAN REQUIRED.
MApy MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERW,NUMBER
RINVTRONMENTAL HEALTH:
SEWAG EWERSOURCE: SEPT7[CEj SEWER❑ NEWD METING❑
PLUMBING M STRUCNAB9 YPS Q No❑ rPm.m dmaFLaV Exv tdepa Fong
PERpq;'TER/FGLMDATION DRAMS PROPOSED? YES ..N00 MSTINGS(IFT.
MSTMG BEDROOMS PROPOSED BEDROOMS�/ TOTAL BEDROOMS�c
OWNER ac"n gee Net subnl¢uan atlnemiate Nlaimetlon mry reauX In Bebp+nM aNsr«pmJl rasmMa.Mkaa+'IeeaemwNd Wdlbty
sianalure ba'mr.IEeGare Hallam Ne wmer aMlNMw batl Ym�la�eddetl�ceNa Nb panill eM b eo lln wvA as prtgvicee.l Nw
obbl�pamilssbn,mm all Ne naceaary P-mas.inGUEln9 en�aM gmn�t empbYeesdMaem Cou��a¢e89 silo Me ewe eewi Nprt{'eM
�aPreanb Hal NeIn(o�maK(go 1
arq�w'¢vum�ysl l«mie«ene inspection.Tw pxmiuevviimom bemnas nun s wio nw«x«eumorzee wnswcHon la ndmmmenma.aNin taD
dry .If pyiNnwMn Mak is suepaiead(m a pWm d,00 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTMTY OF THIS
PERMIT APPLICATIppNN OF 160 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE IAAS,IS) 9113
, �a y
/SW reW _IER IYy/M"•lb� MDEI ky2l OWNER)
DEPA_RTMICK AL—REVIEW APPROVED DATE _DENIED_ DATE TACE'NGTP$/CONDTI'IONS -
BUDDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH
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