HomeMy WebLinkAboutBLD2024-01213 - BLD CD Environmental Health Review - 10/16/2024 MASON COUNTY PermitND: 6 02024' 01213
COMMUNITY DEVELOPMENT
Permit Assistance Center,Building,Planning RECEIVED
BUILDING PERMIT APPLICATION
PROPERTY OWNER UYFORMAITON: CONTRACTOR INFORMATIONrT 14 2024
NAME:TM^`ti""— NAME:""e.s'a'v"°o..w^—"
MAILING ADDRESS:'e°i^"°"-- MARLING ADDRESS:...."' %W ALiarQ
CITY:a STATE:"* ZIP:^"' CITY:? STATE-^""zlp:��,
PHONE#1:a°°'"f0 PHONE:ae°° CELL:
PHONE 112: EMAIL
EMAIL:""""'"e""am" IA1 REG#""®°"m EXP.284L
PRIMARY CONTACT: OWNER 13 CONTRACTORO oTF®I❑
NAME EMAIL
MAILINGADURESS'®n+:u.as CITY°'+` STATE"'" ZIP , �� ar
PHONE CELL
n
PARCEL INFORMATION:
PARCELNUVRER(12Digit Number) N'a w TONING Q �t
LEGAL DESCRIPTION(Abbueviated) FIRE DISTRICT
SPPEADDRESS®E1°'""'"'a""" CITY¢w
DMECTIONSTOSDEADDRPSS ex.rrp.uu"eN.n x.r.xw'ngnacrm...a.«.a"+a.aa.r
ISTRBPAO]ECP�3Nn OFSWPE(S)GREATRRT 14%: YES[] NO[] SNOWLOAD:_Psf
SSPROPERTYWITAKEO FT OP THRFOLLDWIND ] WEILANDy):
SALTWATER(] LAKE❑ RIVER/CR8®C❑ POND[] WETLAND❑ SeASONAL RUNOFF❑ 'TITIAN❑
TYPE OF WORK: NEW❑ ADDITION❑ ALTERATION❑ REPAIR 0 OTHER ❑
USE OF STRUCTURE(dui .cn cum ,Blld,&a)ti
IS USE: PRIMARY CI SEASONALD NUMBEROFBEDROOMS' NUMBER OF BATHROOMS'
HEATED STRUCTURE? YES("nk XW I]' YES WR ftlarwk)❑ NO[]
DESCRIBE WORKwlgip.ewm.u"N...x.raw.wNaww
SQUARE FOOTAGE:Wn n4
ISTFLOOR sq.& 2NDFLOOR sq.IL 3RDFLDOR K.ft BASEMENT sq.ft
DECK sq.ft COVHREODBCK aq.R. STORAGE eq.1L OTHER K.ft
GARAGE sq./t AMMed❑ DwtMil❑ CARPORT q.ft AtlacRrd❑ Ina W❑
MANUFACTURED HOME]INFORMATION: "4 COPEES OF THE FLOOR PLAN REQUItED"
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SE.RSALNUMHO
ENVIRONMENTAL HEALTH:
SHWAGEISEWER SOURCE: SEPTICEI SEWER❑ / NEW[I METING
PLUMBING IRN S'IRUCTURBT YES❑ NO 2/�,,."...s conPkW Water Adng ,Fom
PERI.MESER/FOUNDATION DR7 PROPOSED? YES El 0[] BASTING SQ.PT.�
EXISTING BEDROOMS PROPOSEDBEDROOMS ,(� TOTW,BEDROOMS'
OWNER ackiwMM]es 111Y abNmbi Mlrewweln lnbmiation mey resuX inesltp uwkaexmPamul ravmEw�.PtMiwlety¢mwM1al¢hMty
gpreNre relow.lEWare tivtlem tle wmxan011uMaeetlere Malian wg11e8b�wNw T¢ramileNbtlo Ye TM10 wkun M.INM
obbi�peemuaun hwntl Me mMWrypeNn.Includaq any easement MleerwpstlsJinle�etl repfei�p lulu l'nJaG u"i¢/wbpel
rtwp eshmMY(,.)m min e¢vM Mree(5lMamme.tlmN w paemnwopo—tuw amnewe null
County a2a55b Ylaalu eeaatua]gcpaNy
&wN tl xvk or auMplvO anaWNon i¢�MwmmwcM wMN 1�
d'rn wir�nNmcum wax is wspanaaarwa Perpe a tm Bay¢.
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
COUNTY CODE 1<08A2)
X 9-28-24
Signaaam M OWNER Null:be Warned by Me Dal DM
DEPARTMENTAL REVIEPP APPROVED DATE DENIED DATE. TAGS/NOTFS/CONDI'IONS
BUNDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLICHEALTIN -I
CD
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DEMOLITION FWD TESC
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Thurston County Environmental Health
412 Ully Rd NE ♦Olympla,WA 98506
rn�= 360867-2631
COLIFORNI BACTERIA ANALYSIS
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SAMPLE INFORMATION
Sampb cWbcbd by
SPeolk iOCOM ar addmu Vft aempb Ooeecbtl: Spm.linsbucbmemwerewlle:
625 61aurSa WFle ivtiFS r4
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1,090uue Obbmoum S.7
!/ R.ReMat Sample labrureel.mutire)
Chbdmw Y.—Ni._ ❑DlsMbWon System
Chbr6re Residual:ToW_._Fare_ Chbmabd Yes_Na
s.Rew Water Scum&rm* —'
aeidiW TO: lel_Free__
❑E cdi-GWR(ASP) Chh—R
❑Feral-s,nan.Om.m^sm(n.�w.wnl
Fill&ad.Yee_No_- Dre+asfactorY ieuenabb number
❑Aemm MMmlbiny(AP) - --'---
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4.0 Sample Callecbd for Inbrmelbn Dah'
Imaetigeyre_ Coastru 0Repeira—z off.
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LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY
❑IAmalbpObry Total CdRom Premnl antl
❑E.Wpmmnl ❑Ecod'ebmnl tlebcbd
Regenmem tmmpb Requlnd:
❑Salnmbo ON(130hsare) ❑TNTC 0
BWWW Dmaip Remlb:TOW Cob,_ __ftOOM. EOPf poppy
Fecal Caldmm paaN
EOMmpei "OO M.
Meagd Code: 92238 05M 8222D Dewaa TYre
❑SM92158 ❑Erlbmbrlp .2
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