HomeMy WebLinkAboutBLD2025-00068 - BLD CD Environmental Health Review - 3/4/2025 MASON COUNTY P"maitN°'= WED%
COMMUNITY DEVELOPMENT JAN 21 2025
Permit Assistance Center,Building,Planning
BUILDING PERMIT APPLICATION 515 W.Akiw SbVg
PROPERTY OWNER INFORMATION: CON'T�RA'CT.'ORRIINFORMATION:
N I Af>95S NAM^ ry�U1Kj( L f'C--
MAILINGA DRESS: I, 4 MAIL GADDRESS:
CITY: (.>S STATE: ZIP: CITY:(l41/Ig�iA ~STA'TL yf�Z)P:4 ,SD
PHONE#i: - If PHONE: �Lbc'ffi Tl ed:CELL:
PHONE#2:�'( EMAIL T'
W I NA L&1 RE #fit/L YA Ml6�SYf#EXP. 1 / M
PRIMARY CONTACT: OWNERD CONTRACTOR OTHER[I y
NAME$_I! C EMAIL t—
MAILINGADORESS V4i e�F CITY STATE WA zip-ldsvilp�
PHONE g 1 'y2'�L CELL Te6,
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PARCEL INFORMATION: U o O S
PARCEL NUMBER(12 Digit Numbcr) (2�"Q%/�S1/G 11DA J ZONRNG
LEGAL DESCRIPTION(Abbreavteb) FIRE DISTRICT
SUEAUDRSSS M Al MIL yIIfw CITY IfrDDtPda�
DIRECTIONS TO SUE ADDRESS
IS THE PROJECT winfiN M"'OF SLOPE(S)GREATER THAN 14%: YES(] NO jL SNOW LOAD:_paf
M PROPERTY WI't'IDN 208 FI'OF THE FOLLOWING: IchaBeHd.�.ygr):
SALTWATERD LAKE[] RIVER/CREEK f] POND❑ WETLAND❑ SEASONALRUNOFFO STRPAMD
TYPE OF WORK: NEWA ADDUCN❑ ALTERATION❑ REPmRo OTHERTI A-A,
USE OF STRUCTURE(Acmes..(aemHA coinmercndwdg,grc)
ISUSE: PRIMARY[] SEASONALD NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES fwlweeuy❑ YES/Pnn(el efakW❑ NO
DESCRIBEWORKI,T{.S'I"4M A(aJ 94.11.
S UARET(oAmrm)
1ST FLOOR W.ft 2ND FLOOR eq.ft 3RD UAOR eq.ft BASEMENT aq.H
DECK wi.ft. COVERED DECK aq.R STORAGE eq.R. OTHER w1.ft.
GARAGE K.R Attached[] Detdoad f] CARPORT p.ft ARpchM[3 DemcheAD
MANUFACTURED HOME INFORMATION-
e,,/�n,,,,a,,0'COPIES OF THE FLOOR PLAN REQUIRED-
MAKE��Y'1PrV MODEL540w YEAR`Q [e- LENGTH
WIDTH*—BEDROOMS 2 BATHS Z SERIALNUMBER T/�L
ENVIRONMENTAL HEALTH:
SEWAGFISEWER SOURCE: SEFTIC1)!j, SEWER❑ / NEW EMVMGJ,
PLUMBING IN STRUCTURE? M❑ NO Ify.a,tread comFleled WtwAd dude,Farm
PERIMETRUTOUNDATION DRAMS PROPOSED? YES Nola EXISTING SQ.FT.�
EXISTMGBEDRCOMS--Z— PROPOSEDBEDROOMS-2— TOTAL BEDROOMS_fL
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aymnudn bebn.l drJen NN I em Me owner entl I IUHM1er Jeclere Mel l em entiOeE b receive IM1b Po�mHanH to W NexvM m gqueei.l M1ero
chla4ntl pennbslcnlmm eII1M1e necessary parlim.lnclutling any ememam MlEeror gtllee of InlereBl rpBNiog We pmlacl IDe anrer m kpel
ad sd num(sfwnrdm Osl Me lelmmallmprodnU Ip lio rd-eaotlrankomplold ff o!Masan L000ry occem not tl ince pw n
enE.lmdum(¢)(w mnewanE insPodiw. Thia permNapplig4on bBNmes null flaoiE HwoM or eulM1OAeE CpvWctlm k ml wxnmexeE MNn 1B0
tl.ye ttH¢roWCWn wwk b wegnEeO(ar a grloE of tB0 Eey:
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTMTY OF THIS
PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08A2)
X
S1nelurecf OWNER(Mwt W,I, dbvUn OWHffQ Deb
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTEWCONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH
M�Aj• 7- a._
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