HomeMy WebLinkAboutBLD2024-01489 - BLD CD Environmental Health Review - 12/18/2024 MASON COUNTY P"'"NN- Kt vED
COMMUNITY DEVELOPMENT DEC8y z
Permit Asalstance Center,Building,Planning
BUILDING PERMIT APPLICATION 618 W.Ak1K ShW=
PROPERTY OWNER INFORMATION: I CONTRACTOR INFORMATION: q Z
NAME: NAME:____
MAUAN AD SS: V.O• TT�� CITY ADDRESS: ,..I 3
CPPY:s�QIdYM STATE 2@:�,Q] CITY: SPATE: ZIP:_ = m
PHCNENI:'S/n6- 440.-$"Z/� PHONE Ml-
PHONEkY.'�60 - EMAIL:_ Z
EMAIl.:S A(bn r A VG. sd[1sA f I REG% EKP.__I i_ D
P GWNRR[} OR❑ OnR9t r
NANE EMIL
MAILING DURESS ITT SPATES¢_ZIP
PHONE CELL
PARCEL INFORMATION /////L111111 ������llll cccccc
PARCEL NUAH)ER(12 Digit Nbngw) �T.0277�D�/2�LIDNwG
13GALDE.SCIUPITON(AbbwiMad)_ PBtE DiSIIUCf_
3[IEADDRESS Ly�� CF Cam;PQ HANR CITY,
{I�QL• ' LAA 0
ffiIEC1]Q}IS_'I'�SJ��DITR(SS
U TREPROtRCPWRIHNNBFPOFFL RS)GREATSRTRANI4Y M13 NOE sNOw1AAO:-2SW z tD
ISPROPERTY TY LI (3OFTOPR/OlEl LLOWING: F+WETLANDE IaTO m O
BALTWAlFRO LAKED RIVFP/CRPEK❑ [N)ND❑ WGILAND❑ SEASONAL RUNOFTO $TREAMO p t
TYPE OF WORK: NEWS"ADINTTON 0 ALTERATTOla 0 REPAIR 0 OTTTER PI
[Tse of BTRDcrtaE lX.,u..�..o,w ceAwaArAahI /%ram 2
LSUSE: PWMARYO SEASONAL❑ NVb®FROF N(TMBER OFBAn$OOMS
HEATED STRUCTURBT YE9N+Aa o YES0,. 11wamtl❑ NO.Q/
nrsalmewace w X 62 �✓Ole ��1
Naa aA_..SL aroOTACE aw,.w ---
I.STFLODR "11 ZNDFLCCR q.fl 3RD FI.ODR q.fl BASENENT ft.
DEIX_ R CK f COVEREDDEg STORAGE q.R OTHER p.R
GAMGE4 q.R AOshad0 0emche_13 CARPORT q.R.AOIX o De.wo
MANUFACTURED HOME INFORMATION: -4 COPRSOF TEIK FLOOR PLAN REQUIRED'
MAKE MODEL YEAR LINGDT
WIDTH BEDROOMS BATHS SERIALNIRdBER
SEWAIaTI3ENER SOURCE: SEPHCE" SEWER❑ 1 NEwS/ E>1TSTING❑
IT.UNIDwGw SIaUCTURi^f YESD NO$- lfjw mb.h-14rWWo rAdq Femr
PFRw@IPRIFOTMDwnON DRAD.`S PROPOSEDT YES❑ RDSFINGSQ.R.
E TNG BEDROOMS PROPOSEIIBEDRCOMB TOTALH®ROOMS
ONXER wMtxbGan NRwbmiafbntlheau9einlormAm nvYb+eaba Qp adV IXpertA TIX11bI.Mbiw.YEpaiMlvf WCM1b Ly
garelure[eW l<xlare NYl an Newnan stll wnnartlsl.�.Nallvn erM3fb - Nb PYrA•Mbtr,MawkopgmN.IM
mbhaa Pwrrmm�,aume iai[�Ypaaa Iwa.y srv•+=mba Iwe.ror P.ra®tlne.rrgIXdaP u:w9aa Tn.warnhaY
�greaenbbe rePmwNe MPW mlammOT'pwti]e. a¢und anY VUN wr(M'as JMacn GaalYwxmabMebreEeviM P^PM
Yq gnaL,nlV b rww.vaM Inepemm. oennLe{g4caKn Mmn®tlW BvtlJ YvpX v wRm a![OrKbubarh M¢mrwnw]MUi�ta4
ylami mnMntimxwF b suapmEN M a Vwha of 1N 4aya.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTNHT OF THIS
PERMIT APPLICATION OF 100 DAYS OF MORE WALL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODil I4ARAZl
K ! � /S / S'- 4ye
wRao ueanpwmMft.,. XFF Dab
DEPARTMENTALREVTEW APPROVED DATE DENIED DATE TACS(NOTESACONDInON6
BUR,I)ING DEPARTMENT
AN XGDEPARTMENF
FDtEMARSHAl
PUBLICHEALTH f
o
x smmm
v $gym o - w
E NOV�2 : E:
MASONCOU,Hry NWRON 1
�� ..• ' �, RfT B
0°
oa
44
it . O0 P w
: 3
t v i N ? �6
y .M �