HomeMy WebLinkAboutBLD2024-01128 - BLD CD Environmental Health Review - 9/16/2024 Permit No:��6'I V ED
t • MASON COUNTY
COMMUNITY DEVELOPMENT SEP 16 2024
PermRAMlManwC rftr,EWMNEPlanning 6 W. Alder Street
BUILDING PERMIT APPLICATION LQ �"
IPERTY OWNER INFORME
: CONTRACTOR INFORMATION:
.MRH.E8NAME:MR LOHSIxILTICNILING ADDAESS:`x--cnmbnwMAD,iNG ADDRESS:tfixggMWwenR~W
Y:NmY STATE:wAxrx C)TY:^w'W,A STATE:-AZEaNE#I:x-*--- " PHONE:2--m CELL:NE#2: EMAILAH.:wnx@MnNowlNaxcaMI&.I REG gMnxNxxEXP. /3 / _1
IMARY CONTACT: ER❑ CONTRACTOR❑ OTHERE xvnMxmxwrtwu.owe..... EMAIL atce9NATM-a^°--'ILINGADDRESS t®Ay151EI-TCITY wIm STATE WA 21Px`-- wNE msmt.wa CELL t,RCEL INFORMATION: JCEL NUMBER(12 Digit bf.b ) -°- ZONNGuiawdALDESCRD'RON'(AbErcviMI) seucalsureRz FIRE DISTRICTEADDRESSfitECm3PA LN CRYAL'm ECTIONS TO SITE ADDRESSTREPROJELTWI MN3NnE(S)GREATERT 14%: YES[] NOI] SNOWLOAD:�f Lu
PROPERTY WITHIN 28 FT OFLOWING: R'hafdrelmgq>i:
SALTWATER❑ LAKE❑ RIVE ❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM
TYPE OF WORK: NEW(]+ ADDITION❑ ALTERATION❑ REPAIR❑- OTHER Q
USEOF STRUCTUR3(xenduaw rye.eae.w..mtstda.Oa.)REeDENrlu
LOUSE: PRIMARYD SEASONAL[] NUMBER OF BEDROOMS- NUMBEROFBATHROOMS-
HEATED STRUCTURE, M NPM BW❑ YES(M(+JofBkE,0 NO❑
DESCRIBE WORKNEwsFR
ClJ IA_RF� I' POTACE'fvmAaw)
ISTFLOORI-n sq.R 2ND FLOOR N.A. 3RDFL0UR_N.R BAEEMENT_sq.ft
DECK_xq.R COVEREDDECK`-- eq.6. STORAGE q.ft OTHER_NS
GARAGE--- sq.RARached0i Demahed❑ CARPORT eq.R Atfached0 Dwhd❑
MANUFACTURED HOME INFORMATION: e4 COPIES OF THE FLOOR PLAN REQUIRAII
,,,,,-MODEL_ YEAR LENGTH
W,M BEDROOMS BATHS SEEIALNUMBER
ENVIRONMENTAL HEALTH:
SEWAGEISEWER SOURCE: SEPTIC SEWER N NEW Oa EXISTING[I
PLUM3INGINSTRUCIURE4 YOE) NO❑ I/>Ie,mrach wnP ted Wmer Adegm Form
PERIMETERNOUNDATION DRAMS PROPOSED? ME] NOD EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS - TOTAL BEDROOMS?
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T IS BY
EANS OF
ECTION. INACTIVITY OF
PROOF
PERMF OF R APPLCINUATION ATION OF ISO DRYS OF MORK ON IRE WILL CAUSE CAUSE TIHE APPLICATION TO BE EXPIREDMASONTHIS
COUNTY CODE 14.011.42)
X Oeb
SlaneM1ueINOWNERM as 1 MEv iM OWNERI
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGSNOTEVCONDIDONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
-THIS MARSHAL
PUBLIC HEALTH
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