HomeMy WebLinkAboutBLD2025-00132 - BLD CD Environmental Health Review - 1/31/2025 MASON COUNTY COMMUNITY SERVICES Permit No:j - Dart'
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PERMIT ASSISTANCE CENTER:B RECEIVED
• UILDING.PUNNING•PU&JC HEALTH•FIRE WIRSNAI
015 W.Alar SM,SMron.WA SUM
Plana Snallon 0109-NTOut.362•Fax DW1417.I798 PbM
Bri (OBh ,SH°T.=Eurs (SBal482-Wl9 JAN 31 2025
BUILDING PERMIT APPLICATION
PER WNER INF RMAT CO N'
NAME: S AWE: //�1
MARIN BESS: S4D.ING ADDRESS: Ti•LL
CITY: STATE: ZIP: CITY: STATE:
PHONE# l�—O�L7N PHONE: CELL: IJCA 1 rt
PHONE#2: � EMAIL: —*>�'cCTIT
EMAL: r L&I RED# EXP._/_/_
R A OWNER❑ CONTRALTORI0 OiXEIR❑
NAME EMAIL
MAILINGy�o1DRESg�•L4 CRY STA ZI
PHONE�-iCnlfnl—I�n>a ELL
PARCEL INFORMATION:
PARCELNUMBER(12Digit Number) N7 6Zu--'f{-9(Jb� zG*m+G J
LEGAL DESCRIPTION(Abbrindini FIVE DIS7�'gL1cT �p
SITE ADDRESS�T
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 30 FT OF SLOPE(S)GREATER THAN IO%: YES[] NO[] SNOW LOAi
ISPROPERTYWITHIN300"OFTHEFOLLOWWG: KAr+wIMm�Pb1.
SALTWATER[] LAKE❑ V RIfER/CREEK❑ POND[] WETLAKIl SEASONALRUNOFF❑ STREAM[]
R TYPE OF WORK: NEW ADDITION❑ ALTERATION❑ REPAIR[] OTHER ❑
USE OF STRUCTURE(RnMmce.rAraA cmrawemlBNe.BM.) an
IS USE: PRDHARY❑ SEASONAL❑ NUMBEROF BEDROOMS NUMBER OF BATHROOMS
HEATEDSTRUCTURE? YES(FhM.BWO YES(roiNg"Ball❑ NOD
DESCRIBE WORK AnJ 119
SOUARE F )OTAGE:(am md/
1ST FLOOR_q.fl. 2ND PLDOi 3RD FLOOR_q.fl. BASEMENT_K fl.
DEC q.& COVERED DECK_aq.R. STORAGE aq.R. OTHER aq.B.
GARAGE IOgf- ,.R. Atmehedl Detached[] CARPORT_,& Attached[] DemcAad❑
MANUFACTURED HOME INFORMATION: eJ COPIES OF THE FLOOR PLAN REQUIRED'
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERLU.NUMBER
ENVIRONMENTAL HEALTH:
SEWAGFISEWER SOURCE: SEPTIC 19 SEWER❑ I NEW11 EXISTING[I
PLUMBING IN STRUCTURE? YES jj NO❑ Yfyrm,attach completed Water Adegaary Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NOB EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS
OWNER agnague upWtirme.i, [Mndam,tthat
a i am m e miner and
nINhamipnit ec..remMry l.am ern a l&e'Cpb vNaKcca aNe x MaIX er mmXlma ne c OmM.A+dnr a
oaula am, imam all dye renal annual including ny eaeemmnt mdaa iu panm gra
ce pNnqMo pqM MeM1ae�nrmagaen,l o.o!I nwlag
mural MNlM nfumaGm pmggetbewualre namainly amlaYep MMucn Ccwnry a¢. edw
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roMe'Owe aexnOM prcSMY
andaWfcammfwrevlax&Mid anden. r.,encea yliMtion Cecwnee nY118 vuaaxgkawNanrm]mMWNmCnM¢mmercatMWn1BJ
ary,r°armn�uan rart®eaap.,aee a a p.m]Ml.
PROOF OF C01 TINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERk" CATION 18 AYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
\\ L•/ DUNION CODE 14.01
X an /C.I/-lnUp ell
9 Wre 010WNER M I ne M1 ER Ddla
DEPARTMENTAL REVIEW APP OVED DATE DENIED DATE TAGST'OTEWCONDITIONS
BUILDING DEPARTMENT
- PLANNING DEPARTMENT
FIRE MARSHAL
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PUBLIC HEALTH
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M.Halverson Design LLC m"°"1°°°"®°` 11
cw rcrva *x[xrs uc Reseltlng Parcel C OI BLF3013-00062
PO Box 1619Shelton We 9858C oz oow sxs ox vucsv w nGk22ttlei
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