HomeMy WebLinkAboutBLD2025-00051 - BLD CD Environmental Health Review - 1/16/2025 MASON COUNTY Permit No: 6t-U
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COMMUNITY DEVELOPN IVED
Permit Assistance Center, Building,Planning BAN 15 2025
BUILDING PERMIT APPLICATION
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PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: 9y
NAME: C_ahA.-(24-ia R, I d B-S L.L,r NAME: ADDRES a'
MAILING ADDRESS: MAILING S:P s
CITY:Y1];r1ln.r,^A STATE:7M ZIP::: ¢ CITY: Ult�ln� STATE: L.A ZIP:
PHONE#1: PHONE:' CELL: - -
PHONE#2: EMAIL: i P 1
EMAIL: L&I REG# 2 EL (P.II )2—)Zv
PRIMARY CONTACT: TOR4 OTHER❑
NAME Ti-C.V k S V t l(I OWNER❑ CONTRAC
V�PS _ EMAIL if dl Yac y{'r/-1 per a7�Mn,LcJf.,
MAILINGADDRESS _t'e Rlr II-190 CITY STATE 1,4 ZIP
PHONE CELL 7L4-17,6
" PARCEL INFORMATION: Coo r M ENTAL
PARCEL NUMBER(12 Digit Number) LW I Q — "-AO "OO II V ZONING f I LA LTH
LEGAL DESCRIPTION(Abbreviated) Ltl.ke (`_.tAV%wn*, #i b -M 1l(a FIRE DISTRICT
SITE ADDRESS SO t) CCli rP CITY 40nk Rkt
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14Y: YES[] N04 SNOW LOAD:!ytpsf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Cherkdl rharopply):
SALTWATER❑ LAKE❑ RIVER/Cl ❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEWO ADDITION ❑ ALTERATION ❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Beelderm Canal eammrmial Bldg Ea.)
IS USE: PRIMARY SEASONAL❑ NUMBER OF BEDROOMS_ NUMBER OF BATHROOMS
HEATED STRUCTURE? YES OFhole Bldg) ff YES(Pat/a]olB1dg1❑ NO❑
DESCRIBE WORK MIA ._daft, I'Lo v-_4
SOUARE FOOTAGE: (p,apa=ed)
1ST FLOOR 1e SSb eq.fL 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.R
DECK--60_sq.& COVERED DECK sq.& STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.fL Attached❑ Detached❑ CARPORT sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION:
C� w4 COPIES OF THE FLOOR PLAN REQUIRED"
MAKE T IQ(�F(,LUO(YI - MODEL a �Y O 3 C, YP-AR,`2()a1 J LENGTH W
WIDTFOUrS'/l BEDROOMS_ BATHS C9 SERIAL NUMBER
ENVIRONMENTAL HEALTH:SEWAGE/SEWER SOURCE: SEPTIC SEWER ❑ ) NEW) '
EXISTING❑
PLUMBING IN STRUCTURE? YES'q NO❑ Ifyes,attach completed Water Adequacy Form
PERIMETERMOUNDATION DRAINS PROPOSED? YES❑ NO[] EXISTING SQ.FT.
nXiSTINGBEDROOMS PROPOSED BEDROOMS S TOTAL BEDROOMS—3_
ER scolovAedges that submission of Inaccurate Infonnatlon may result In a stop work order or pennit revocation.Acknowledgement of ouch is by
re below.I declare that I am the owner and I Tither declare that I am argued to receive the permit and to do the work as proposed.I have
I permission from all the necessary parties,including any easement holler or parties of interest regarding this project The owner or legal
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PROOF OFCONTINUABON OFINORK ON THIS PERMR IS BYMEANS OF INSPECTION. NACTMTYOFTHIS
PERMIT APPUCATIO F400DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
Q�` COUNIYCOOEIC09AT)
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(Must be Waned Wthe OWNER) Dare
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