HomeMy WebLinkAboutBLD2023-00343 - BLD CD Environmental Health Review - 4/28/2023 r MASON COUNTY COMMUNITY SERVICES Penwtm: .Lean ',
PERMITASSISTANCE CENTER:
•BUILDING.PLWrytNG.PUBL/C NEALTH.FPE MgRSHAL /r J'�
615 W.Naar BheeL BMlbn,WA 88561 - rL
Ph SI m:(W)43IA610 eW 3$2.Fp (360)44]-ng lP
BMeN PW)273 6].Mwe Emma:(3WN813389
MAR 2 s �z'
a ENVIRONMEnJ A�
BUILDING PERMIT APPLI6/wflbNglder so-
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: d ( NAME:
CITY: ADDRESS: - MAE.WGADDRESS:
CITY: STATE: { ZIP: CITY: STATE: ffi:
PHONE NI: PHONE: CELL:
PHONE iIl: EMAIL:
EMAIL: L&1 REG4 EXP.
PR RY CONTACT; OWNER CONTRA❑ OTHERMAMIN
m N Milli
NAME (�,}j(((E EMAIL C
PHONEG,a9p 5 p7�Q� CITY SI'A X� tv
PHONE - �5.1-7� CELL � � o
N
PARCEL INFORMATION, p PARCELNUMBER(12 Digit Number)
LEGAL DESCIUT/TT�IO��N(Abbreviate FIRE DISTRICT
STPE ADDRESSAQ- [W' 11W� t f }rQ g
D IONS TO SITE ADDRESS '��SMQE dt J A.`CITY aw
J ATa JT
Mat I ! LrA'�Zd
IS THE PROJECT WITHIN J00 FT OF SLOPE(S)GREATER THAN 14'/a: YES[] NO❑ SNOW LOA ,: f
ISPROPERTYWITIIHi2WITOFTHEFOLLOWING: ICJaa.BN«. ,:
SALT WATER[] LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOPP O STREAM❑
TYPE OF WORK: NEW[] ADDITION[] ALTERATION❑ REPAIR❑ OTHER fl
USE OF STRUCTURE(R«:d aa,ca,c..m,rc:.twsa.Bk)
IS USE: PRIMARY[] SEASONAL❑ NUMBER OF BEDROOMS_ NUMBER OF BATHROOMS_
HEATED STRUCTURE? YES(wade Nst T7 VES mvWddAlagl❑ NO
DESCRIBE WORK [1 NIPS
SOUARF_FOOTAGE:
IST FLOOR_K.& INDFLOOR_N.R. 3RDFLOOR_Hq.ft BASEMENi_yq,ft
DECK_aq.fl. COVERED DECK_%ft STORAGE N. OTHER3Do tq.R
GARAGE_6y.ft. Asmched❑ lkmched❑ CARPORT sq.ft AiaAa 1] Demchd❑
MANUFACTURED HOME INFORMATION: V COPIES OF THE FLOOR PLAN REQUIRED.
MAKE MODEL
YEAR LENGTH
WIDTH BEDROOMS BATHS SERVAL NUMBER
ENVIRONMENTAL HE ITH-
SEWAGENEWERSOURCE: SEPTI SEWER[] / NEµ•[] EXISTIIV
PLUMBING IN STRUCTURE, YES[]1I Np� Ilyv,artoeh mmpI awl Adeq ry Fomr
PERAfETER/FOUNDATION DRAINS PROPOSED? YES El N[sPT EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS l\TOTAL BEDROOMS
OWMER ecknoxyaeas bat au«niunn ommacwrata mlpmalion m.r raeuH m e abp waM«e«or.ermH rtroutbn.gynw,yaganyaaaW i.by
aaaa^u�re below. tlepen bet ern be caner ana NM«tleuen uut am adMM m recNro bu peemit ane la eeuia xnk ay peppyea. M1ay 0elmmwn horn aH Ne rycessen ara.,mu....9 any`aa—am b«aer«paNea aiMereel re9aedry Nb amfaet Tae am««level
raoresenteYve,mpteaeme bat lM lnl«metion pma9e'n eccurab na grams«npwyees otMssm Counry eawa b tlw above aeevibea popeny
aM amcbn(s)brreNewantl i�wPeaimi. Tbh parmNeOd'ieetlon bewnesvoia Hwwk or autlnrizea ConapuCyon is nat commencetl witivn i60
aaP a HwmM iron wrk B surnames br a,—,om 180 says.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLIC TION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
( COUNTY COOE 14.08.Q)
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DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGSINOTESICONDTT1015
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH
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