HomeMy WebLinkAboutCOM2025-00011 - BLD Application - 3/3/2025 MASON COUNTY Permit No: "yyr,eSZS o00� I
COMMUNITY DEVELOPMENT
Permit Assistance Center,Building,Planning
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:^°'— NAME:1°°
MAILING ADDRESS:"wa' tahv MAILING ADDRESS:—
CITY:— STATE: ZIP:°'°' CITY:— STATE:mo ZIP:^e
PHONEd1:—"°' PHONE:' CELL:
PHONE 92: EMAIL:—
EMAIL:°""°w^a°"°w"mm" L&I REG R
PRIMARY CONTACT: OWNER@ CONTRACI'ORO OTHERQ
NAME rE+.. EMAIL
MAILING ADDRESS"w°x°' aaa CITY°+^ STATE ZIP=
PHONE`^`+""` CELL
PARCEL INFORMATION:
PARCELNUMBER(121)i9it Number) -"°°°m° ZONINGw`mn1°"eaea °'wx'
LEGAL DESCRIPTION(AbbreviMW) f1PE°a"a1NF1 FIRE DISTRICT owe
SITEADDRESS^°'a"w'a .
DIRECPIONSTOSDEADDRESS'"'"Tw.wrww..exmemiw»°wxnx.nnxnw rnrww+x.xr.iaws ax.pxe.gaw
wE wamx*.n M m.w omrE.m
IS THE PROJECT WITHIN 3W RS OF SLOPES)GREATER THAN 11%: YESQ NO @ SNOW LOAD:_,af
ISPROPTEE13 LARE[] RIVERREFOLLOWIND lQ WETLAND[]
SALTWATER❑ LAXE❑ RTVER/CREEK� PONDQ WETLAND❑ 9EA.SONAL RUNOFF@ STREAM❑
TYPE OF WORK: NEW @ ADDITION❑ ALTERATION 0 REPAIR 0 OTHER
USE OF STRUCTURE/A.ndmv.G ,,comeadd But.Em)v"'w°x
ISUSE: PRIMARY@ SEASONALo NUMBER OF BEDROOMS NUMBER OF BATHROOMS_
HEATED STRUCTURE? YES IPm+' euy❑ YES lmm()yefiW @ NO[]
DESCRIBE WORK'"'. --eeaea—...""'�"�."'
SOUARE FOOTAGE:omE,x9
IST FLOOR p.ft. 2ND FLOOR° q.& 3RD FLOOR_q.& EASEMENT K.ft
DECX- % COVEREDDECK° p.R. STORAGE° q.11. OTHER° p.R.
GARAGE° q.ft. AUmOmd❑ Dwiad❑ CARPORT p.RAn [3 Der [3
MANUFACTURED HOME INFORMATION: aA COPIES OF THE FLOOR PLAN REQUIRED-
MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWERSOURCE: SEPTIC SEWER I NEW@ EXISTING❑
PLUMBING IN STRUCTURE? YES @ NO T1f ma.eumh mmplme Ware,Adah ma,Form
PERBNETERIFOUNDATION DRAINS PROPOSED? YES❑ NO@ EXISTING SQ.FT.
EXISTING BEDROOMS° PROPOSED BEDROOMS ° TOTAL BEDROOMS °
ONMER bmoaaAI deca nu:at I a maim , ram Ibmerde,me that
ream in a mt �ee aNnar Parma nd W ea th AC *aff Ppeaenl dmxA u ay
agmmre xmw.i••mare that i am ire owner am l wnnare«mre mm l am musae m reaemeaNa vermnene m ea mE wn.a papaem.i Iuw
°m.inm Pann..ion rvom an:na renaa.ery v.m«.in<wmrq anv em°mam maar°r panty m Imaren revamine dt'.pasty. mew,m.«i.p.i
arose murve.revrearmuu:ma'nme $Mm ia.reunm°nea n w&g id, n sowsae ei po°eM
aM orffw m remx k u"p d. ra px:mNaPPlullonMrnnea Emiavale nwwX aeuWnme m'nwctl°n undwmmercea eAMln 19Y
saner rmmmamn wan<i..a.wm.e mr a reeoe n 1M eava.
PROOF Of CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTNTTY OF THIS
PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE I/.08A 1 1
X � � /16/2025
SWaWm WOWNER(MuetW akneE bviM OWNERI Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAG&NOTESICONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH �/ I
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