HomeMy WebLinkAboutBLD2024-01393 - BLD CD Environmental Health Review - 12/2/2024 PermE No: Bj-p202A-6 hyg3
MASON COUNTY
COMMUNITY DEVELOPMENT
PesmftAs nre Center,BWIeim Plannim RECEIVED
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: NOV 20A
NAME: JARD" P-DGIUF. NAME: 0 1T cam' ����`
MAH.WGAODRESS: 1�lO taw CAI a-IF.H�T MAHJNG ADDRESS: 806et
CITY: C(:RT�Aaln STATE: OR ZIP-11�i CLTY: f.LE Et OM STATE: �A ZIP:QRN�2
PHONE#l: c c-•ii:- Tla✓,cI_ PHON&<rsi.P ,a rriFELL:
PHONE#2: EMAIL: SPJDZZ.AnC GM Alt .fnnA
EMA]L—,&,rltcr R UE[FaM wtl .fnnA L&I REG# �/ EXP.
PRIFIARY CONTACT: OWNER❑ CONTRACTOR❑ OTHER PJ
NAME \GS:it IA fxRwarT EMAIL—jq M ms.�RRfr-.TC_{:{,.1kt%'R1 uS COM
MAUUNGtD,M55 �9G C -"�nP r;µ `l CITY iCld.m.1 STATES ZIPOrmQ25
PHONE Cw;�+_'O.b. Sb A CELL
PARCEL INFORMATION: OL
PARCELNUMBERo2Digit N.n ) 92109 -s%ral^ d'!A, ZONONG R-2 n �
LFAALDESCReT10N(Abbaevietd) I nµF fUStthnA Al ai'I OL r-crL FIRE DISTRICT tn� 4' L
SITE ADDRESS S',ot N NK:UTAIN U F\n/ Rf) . CITY HGCDSDORT F
DIRECTIONS TO STIBADDRE55 ('A �HM A-AI � O�
ISTHEPR0.TECTWI'1'1m0300WOFSLOPE(E)GREATERTHANI4%: YES N SNOWLOAD:lD-w
LSPROPERTYWITBIN200FTOFTHEF0LL0WDVG: (cl stdtam gpyJ:
SALTWATER❑ LAKE❑ ]UVEWCR o FORDO WETLAND❑ SEASONALRUNO"D STREAM❑
TYPE OF WORK NEW Qr ADDITION❑ ALTERATION❑ REPAIR❑ OTFIER Fl
USEOFSTRUCTURE(xuMxe.foge.roenem'mi ) RFS'DIF . CF_
ISUSE: PRIDIARY❑ SEASONAL OFBEDROOMS I NUMBER OF BATHROOMS--_
HEATED STRUCTURE? YES tRNu'aRMO YES?WJdRI{N❑ NO
DMCR®E WRRK
SOUARE FOOTAGE:omp—a
1STFLOORZ34 q.R 3RDFLOOR q.ft BASEMENT q.fl
DF ZK Zq.R COVEREDDECIC q.R STORAGE q.ft OTNER q.&
GARAGE_q.ft Aga W11 Dm 11 CARPORT a0.ft A0 D Dc Wo
MANUFACTURED HOME INFORMATION: a#COPIES OF THE FLOOR PLAN REQUIRED'
MAKE MODEL YEAR LENGTH
W Dm BEDROOMS BATNS ccatAl.NUADIER
ENVIRONMENTAL HEALTH:
SEWAGWSEWERSOURCE: SEPTIC SEWER❑ I NEW❑ EXISTING
PLUNOWGINSTRUCrURE? YES,- NOD lfP ,,mmrAc lddWxvAdq Form
PERD4T' TOUNDATION DRAINS PROPOSED? YES Nqgl� EXISTINGSQPT.
EXISTDNG BEDROOMS PFOPOSEDBEDROOMS__L_ TOTALBEDROOMSJ
DWNEp rYrvxle3dee tlul wEmYpbn Winev�mm FJmnatim m%rmJl ins Npp naM1 gaarvpemiX e11on.P.k^sxmislpmeNdeu'lib Ey
1gMWA bba'.I Jetlere Eel l am ue wmmmN I NnM1a tlecbre Mel l am mNkE M mceive Inb pertntl antl:a ao Mexuk tl gCpYaa.I liN
eNalneE pamiscon hom JI Na rexseary paNa¢,InduElnB eny eaummt Mltlera W Noe N In:aresl regeNln9lnis pmjeq.Tp pwnrslegal
�gawiNtiw.�apawMs Mat Me In(oimatian paMetl i¢ecwre:s an0 greens employees of Mason Cwm:y aozss to Me aW.e awIEM pgaM
.. aro.wm.efgro-nwr.ma'.npacmn.mape�mlvepprreao.taor�aa��nawia a.mo,auon:ee snow tion'¢m�.n.nwa.Fn:�tm
tlar¢«nmuucnm ao,x b anpvEM Nu.P®ba d too eeya.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMR AP LICATIO 80 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
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B' and OWNE Mu el netlb M O DaM
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGSRNOTESICONDMONS
BUBDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH I
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