HomeMy WebLinkAboutBLD2024-01211 - BLD CD Environmental Health Review - 10/16/2024 Permit No: i(-�f�jI
MASON COUNTY
COMMUNITY DEVELOPMENREC E IV ESE NVI RON MENTAL
perinit Asslstanee Until 6N1MMI,Planolny nn HEALT
BUILDING PERMIT APPLICATION'�T PO24
PROPERTY OWNER INFORMATION: cONTRACT ®14: r
eet
NAME:YEEIPI.UJRa DBIa%GWs MlNDYE NAME:i.ana.Dtamamsat lmaamea Q ��
MAR.INGADDRESS:—''t°^DeE'' m MAILING ADDRESS:np'SE Eem.eia �T
CITY'B+"we STATE:wA ZIP:°°°m CITY:B+^sarcoma STATE.wA ZTP: l6
PHONENT:' as PHONE:--I— CELL: j
PHONE#2: EMAIL IA.pooD oaadmm `
L&I REGNwatnmtw gEp, 6 �22
PRDKARY CONTACT: OWNER[] CONTRACTOR pi OTHER❑
NAME EMAIL l.wo^Rv.Mwm"
MAILINGADDRESS CITY�... . STAR wA LP—
PHONE mmaapar CELL
PARCEL INFORMATION:
PARCELNUMBERI21%Rit Nambv) =iwmw WNDIGRM
IUGALDESCRIPTION(AbbeevleteL) SMaOMp REBTMDIERAT1 tAT.N FIREDISTRICTe
SITE ADDRESS CITY.
DIRECTIONS TO SITEADDEFSS On Esba.YN W aem.o E.M.I.MEM E awNb.crw
ISTHKPRO2KCTWITRENMOITOPSLOPK(S)GRKATKRTRANI4X: YFSpi NO[] SNOW'L0AD:2!-1.I
ISPR0PKRTYW[EBIN2EOFPOPTDRPOI. JNG: tCM1. apppogPy):
SALTWATERpi LAKEpv R]VER/CREEKO POND❑ WETLAND❑ SEASONALRUNOFF❑ STREAM[]
TYPEOFWORK: NEWS ADDITION❑ ALTERATION❑ REPAIR❑ OTHKRO
USE OF STRUCNRE/IA✓6ur<OmT.Cwmmd R6Q,9c/OmmYMtlmm
ISUSE: PRIMARYQ SEASONAL❑ NUMBER OF BEDROOMS?NUMBEROFBATFEROOME2
NEATED STRUCTURPI YES(wak Augl pi YH4 fPmgJbW#J❑ NO p
DESCRIBE WORKxwepDOp NNAa Ema m a Pbmdu.Paryia.tlam.
ROUARF FOOTA L(PaPmnp
IST FLOOR W as, ft 2ND FLOOR q.ft JRD FLOOR all.R BASEMENT q.ft
DECK q.ft COVEREDDECKw q.ft STORAGE q.ft CTHER_q.R.
GARA013 ,ft. ARaeheAp Detmlvd❑ CARPORT__,It ARBCMdp DempW[]
MANUFACTURED HOME INFORMATION: •A COPIES OF THE FLOOR PLAN REQUIRED'
MAKEwa° MODEL' YEARMI LENGTH%
WDYTHM'tN' BEDROOMS2 BATHE SERW.NIIMBER
ENVIRONMENTAL HEALTH:
SEWAGESEWBR SODRCE: sEPncp SEWEK❑ I NEW[] EwsTINGp
PLIIMBINGINSRULTINtEf YESQ NO❑ pya,mmpAmmpbyb Nmn Adegazy Form
PERMETEIt/FOI/NDATION DRAMS PROPOSED? YES❑ NOE] EXISTING SO,IT. ^'e
EXISTING BEDROOMS — PROPOSED BEDROOMS a TOTALBBOROOMS t
MNER acduvbEBea NN aWnbaM or Yum..b L ionarwan may result In a stop vole owes or pemvl trvcoUm.Mbmvb]peamd d.W b by
.NrWnlGwv.l Ueden Ne11 antlnarerennIMNa Eetlere NatI amentWedtorec NbpsM mLota'M gep lM
ppWetlgmiubnM1dn tll Nie nmessay Ptaa,MWdrtq enyeasement Mldera peNea NInMCLtepeNrytlib pN,ed. TMwma«bpel
teryesenlea.,reptuemattW tlw Yil«nuW pmNded is ecevttle end BmntsanpbyzeaIXMeun Canryeumebtle�oaedumbed ppRtb
d dwute(a)Iartaunt+«lemspnc ra penrvdiWd4m ammeatw8wie n.whaatutazee mnebucfpn iarmtmmmmwd ruln teB
ay.«nmmwrmnwx is aoaanned rora p«la a teB data.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVTNY OF THIS
PERMIT APPLICATION OF 180 DAYS OF MORE W ILL CAUSE THE APPLICATION TO BE PIRED.(MAEON
COUNTY CODE 1A.09.A2O l6 /I0/
X ( V o[
BMttaEnaW ER RAmlbe alanaE bvtlte OWNERt Dale
DKPARTMKNTALRKVlFW APPROVED I DATE DENIED DATK TAGSONOTES/CONDTTIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FINE MARSHAL
PUBLIC HEALTH
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s`'C f" MASON couNrYFNV!g,,,%, NTI Nr PAULA JOY�JOHNSON''..
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