HomeMy WebLinkAboutBLD2025-00125 - BLD CD Environmental Health Review - 2/3/2025 Permit Nn:W&A5'(W
MASON COUNTY RE EIVED
COMMUNITY DEVELOPMENT � �
PermitMrINnee Cmteq BulWlrle,HanninE 1 "'-JAN 31 2025
BUILDING PERMIT APPLICATION
PROPERTY OMMRR INFORMATION: CONTRACTOR DNF RMATI er Street
NAME:( 2 M-Mmn6h
MARWGADDRESS: GADDRESS:
CITY: STATE: ZIP:�y3'Ry CITY: STATE:_ZTP:
PHONE p1: PHONE: CELL:
PHONE N2: EMAI.:
EMAIL: LAI REG N EXP. /_/_
PRIMARY CONTACT: OWNER CONTMCTOR❑ OTHER❑
NAME EMAIL-
MAIUNGADDRESS DELL CM—STATE—ZI
PHONE P �
Ip
PARCEL IIVFORMATION: or j�f
PARCELNUM13E1(121igit Number) 31 122— p—`Jool2 ZOND+G Q
LEGAL DESCRIPTION(A Irieted) FIRE D I S TMI kiCr
SITE ADDRESS CITY
TeA
DIRECITONST grrF ADDRESS l W U96i A>T Erg {n4Sy 5 O
wr /eft o WITHIN
�x k 60 - drF is Ole
. d
IS TEE PROnCT IT IN 30 F1'OF SLOPE(S)GREATER THAN 14%: YES$ NO o SNOW LOAD:ytPsl
IS PROPERTY VMM 2W n OF THE FOLLOWING: l Non*,dl amrop*l:
SALTWATER[] LAKE[] RIVERICREEK❑ POND❑ WETLAND[] SEASMPkLRUNOFF❑ STREAM[)
TYPE OF WORK: NEWX ADDITION❑ ALTERATION❑ REPAIR O OTHER n
USE OF STRUCTURE(Andderoe GmarO,Tom veil&$,Z'm)
IS USE: PRIMARY SEASONAL❑r.� NUMBER OF BEDROOMS 7— ?RJ)4BEROFBATHROOMS�
BEATER STRUCTURE? YES(Nhde Pldg))( YES fAm(. ajlAdgl❑ NO❑
DESCRIBE WORK '
SOUARE FOOTAGE:rDnYor00
NET FLOOR u1.ft. 2ND FLOOR_aq.R. 3RD FLOOR_w1.ft. BASEMENT_K.R.
DECKaq.R COVEREDDECK_sq.R STORAGE srkl ft OTEIR_N.R
GARAGE aq,ft. Awched 0 Derached❑ CARPORT sq.R Attached❑ DetaoW
MANUFACTURED HOME INFORMATION: '4 COPIES OF THE FLOOR PLAN REQUIRED'
MAKE MODEL YEAR LENGTH
BEDROOMS BATHS S
ENVIRONMENTAL HEALTH:
SEWAGEISEWER SOURCE: SEPITCA SEWER[] ) NEW EXISTING)(
PLUMRWG IN STRUCTURE? YESA NO❑ djyer,armch noWlered Ware,Adegwry Fong
PERIMETER YOUNDATION DRAINS PROPOSED? YES)4 NO[] EXISTING SQ.Fr.
EXISTING BEDROOMS PROPOSEDBEDROOMS 9 TOTAL BEDROOMS_Z—
OWNERacknkrWoEges tbal su[mbrbn of"000ds nlwmation m resell F A won"a4r u aennB lewGtlan.ibnaaMdp kenlda 's by
.,.lure belox.I condor der Nr the waar and;I NMx EWare nod I am woWroIW reow",di pimilW todo ft...pndpo"d Iluw
Wr01 tlpem�isaWnlmm alltM�YttaserypenM.axlednp OnY enemenl Muter or penws of inlereNIBOB�rknd tlYe pgeaL TbO omyr alepal
repreumatiore,rrrpn nla Ndl the InlannaAca pWvided iavaaele and grams emgoyees of Mum Ccunry Nieu WIbeabue EaOaibe]paP0r1Y
r.slruoture(s)for miew and Nrpectlm. T,,pemipaFfYradm Woo nes nul b void Hwork or aulMn'rsJ Mrsn oticn i M ranmercM wthin IN
days or ncpu.n work is our WW M a Mood on IN dw,
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF 388 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.88.42)
Sgne re ofOWNER Irk G I rotlbvlM OWNERI ale
DEPARTMENTALREVIEW APPROVED DATE DENIED DATE TAGSANOTESlCONOTIIONS
BUILDING DEPARTMEN
PLANNDJG DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH
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