HomeMy WebLinkAboutBLD2025-00059 - BLD CD Environmental Health Review - 1/7/2025 MASON COUNTY g�p8oa5�0005�
COMMUNITY DEVELOPMENT RECEIVED
Permit Assistance Center,Building,Planning BAN 15 2025
BUILDING PERMIT APPLICATION Zr treet
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:NAME;--.A� . NAME:MAILING ADDRESS:^ —'- MAILING ADDRESS:rowmCTTY:^ STATE:wA ZIP:aeeN CITY:A.r.... STATE:M^ Z1P. 'PHONE#1:>%a+�" PHONE: CEfY: Nu..n'w PHONE#2:—Nae'w EMAD.EMAIL:M"'+aB""�°' L&I REG#'wlaratam� EXP. /
PRIMARY CONTACT: OWNER[] CONTRACTOR❑ OTHER13 ---�
NAME p..u.� EMAIL arw�.ma.mn
MAIONGADDRESS ap"wFmW. °'."g OTT gx.e. STATE eM 1��1I�I�('('JAn
PHONE CELL NMENTAL
PARCEL INFORMATION: HEALTH
PARCELNUMBER(12Diga N=b=) '�^''a 10 ZONING^8' �l
LEGAL DESCRIPTION(AbbmiaNd) Raw ":M a w FIRE DISTRICTa
SITEADDRESSMMa°"P^+.,°°P— CnT M^
DI RECIIONS TO SITE ADDRESS ndnXry'4lswml.mn Mlma G.pNwluq Rsa.Melam Mappmtmaw
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NOD SNOWLOAD: f
ISPROPERTYWITHE4200FTOFTREFOLLOWING: A:bgdlauA�/y/.
SALTWATERO LAKE❑ RINER/CREEK❑ POND❑ WETLAND❑ SEASCNALRUNOFF❑ STREAM❑
TYPE OF WORK: NEW❑ ADDITION❑ ALTERATION O REPAIR❑ OTHER n
USE OF STRUCNRE(nrsnm.r�vae,ts..remld Nea Er)mrew.ee..Rem,
ISUSE: PRIMARY- SEASONAL❑ NUMBER OF BEDROOMS a NUMBEROF BATHROOMSe
HEATEDSTRUCTURO YESmnd (a N(;❑
DESCRIBE WORKR'"�q•m"'PeuwRourrwnerwn.rem,..Pmlm..y
$-DARE FOOTAGE:aaaaa.y 38C)eajGI'\tw-odtx
ISTFLOOR aq.8. INDFLOOR aS.R JRDFLOOR_'.fl BASEMENT_aq.I
DECK %,.R COVERED DECK—K.ft. STORAGE aq.R OTHERa+ YZay.R
GARAGE sq.R. Attached[] Dawched❑ CARPORT wi.fL Attached❑ Dewddd❑
MANUFACTURED HOME INFORMATION: •4 COPIES OF THE FLOOR PLAN REQUIRED-
MAKE MODEL YEAR LENGTH
WRYTH BEDROOMS BATHS SERIAL NUMBER
ENJRONMENTAL HEALTH:
SEWAGFSEWERSOURCE. SEPTIC[]. SEWER[] / NEW❑ EXISTING}7C
PLUMBING IN STRUC RE? YES O NO❑ bryea.=A cpWevAWwee Adequ Form
PERIMETERIFOUNDATION DRAINS PROPOSED? YES[] NOO EXISTING SQ.FT.
EXISTINGBEDROOMS d PROPOSEDBEDROOMS ' TOTAL BEDROOMS • S 7007.OD14
',. OWNER skrmMWOes Md sridrvmm W iiacv .Momalicnm% M."xvk vCva Pamil rem.Ad..W1emmlgwMLLty
slanaNrebel ldNwMM l an thw Ke d l NMmdmsxtlul l gnddRedmre-e MPgme. dMt Teeako PNuvN.ltae
Mmi�d pertnia¢ion M1un aN,M naceury prtiu,indWNO e^Y aaw^erdhdda'w ParUea gc'x.q rpergrq We prgM TM carer u Iqq
repra9anl611wrepresents NM the inlwmaticn VmNdetl¢etarate ap WwLLempW>at of Neem LanlY xtev more aboe ammttl pmpXy
and aWdgelal Ica reNrovand Inspenlm. mIs pmmluapgiralm Eemmn rme awia irwk a aRu'vm cautrumpn la rwlmnmasedrflM 18D
Jaya ar rcmna+�aar.An is saw=ndae rma perud d Iro days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF I OATS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
X � 'J,/,/�a"✓a� COUNTY CODE 14.08.42)
&DINNER(Ram Easier"W M.OBMEfn
DEPARTMENTAL REVIEW .APPROVED DATE I DENIED DATE TAGs/NOTES/CONDTIIONS
BUI DMG DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH
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