HomeMy WebLinkAboutBLD2024-01118 - BLD CD Environmental Health Review - 9/23/2024 Pernik No: _0 U
MASON COUNTY
COMMUNITY DEVELOPMENT
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BUILDING PERMIT APPLICATION Lo� q J'
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PROPERTY OWNER INFORMATION: CONTMCTOR HYFORMATION• �
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NAIILI Mr ADDRESS
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PRIMARY CONTACT: OWNER❑ CONTRACTOR❑ OTHERG
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MAILING ADDRESS tine svtstttsr CITY"^ '—
PHONE�I- CELL
INFORMATION:
PARCELNUM1IDER(12 Dipjt Number) tg °d10p° ZONING
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LEGALDESCRUTION(Abbxviexd)�TM+wr'e MKetswuz FBtB DISTRICT
SHE ADDRESS CCW st E PMS LN C
DIRTTY,V1vx
DO3ECTIONS TO SITE ADDRESS
MTHEPRO.IECE WITDIN O{B FT OF SEOPE(S)GREATER THAN IdVe: YESD NOG SNOWEOAD: rd
ISPROPERTY WITHDI3MI FT OF ERE FOLLOWING: ICFtldeMmpph1
SALTWATER❑ LAKE❑ RIVER/CItEEK❑ POND❑ WET AND G SEASONALRUNOFF❑ STREAM❑
TYPE OF WORK: NEW G ADDITION❑ ALTERATION❑ REPAIR❑ OTHER Tl
USE OF STRUCTURE(Anluema,trwea.CmweNd em¢.F,nJ REamENTMI
ISUSE: PRIMARYOO SEASONAL❑ NUMBEROFBEDROO Oao NUMBEROFBATRROOMV
HEATED STRUCTUEEt YES IWIde�❑ YES IPm/rl fT 0
DESCRIBE WORKmmM
SQUARE FOOTAGE:PP m
ISTFLOORten N-1 2NDPLCOR_e9 R '"FLOOR—Mk BASEMENT_sq.ft
DECK_sq.R COVERED DECK tee "It STORAGE R,% OTHER_s9.IL
GARAGE+°°sq.ft Demehed❑
Awn Detached❑ CARPORT �.ft Artoched❑
up
MANUFACTUIRED HOME INFORMATION: *1 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WD)TH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGFISEWER SOURCE: SEPTIC SEWERG / NEWG EXISTING
PLUMBING IN STRUCTURE YES G NO❑ Uxa.utuch mmyleted Winer Ade lzP Form
PEFIMETERffOUNDATION DRAINSPROPOSEDp VFSG NOD
EXISTING SQ.FT.
EXISHNGBEDROOMS PROPOSED BEDROOMS s TOTAL BEDROOMS
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PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIWTY OF THIS
PERMIT APPLICATION OF IN DAYS OF COUNTY W LL CAUSE T E APPLICATION TO BE EXPIRED.(MASON
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Sgndure of OWNER IM MM M Mb N DWNERI
DEPARTMEM'AL REVIEW APPROVED DATE DENIED DATE TAGS�VOTES/CONDTTIONS
BUDDING DEPARTMENT
PLANNING DEPARTMENT
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