HomeMy WebLinkAboutBLD2025-00195 - BLD CD Environmental Health Review - 3/12/2025 Permit NO:__F�����5
MASON COUNTY
COMMUNITY DEVELOPMENT FEB 18 2025
Permit AssisblKe TN14e,BWIWy,%Mnlna
BUILDING PERMIT APPLICATION q�T$trgpt
PROPERTY OWNER INFORMATION: CONTRACTORINFORMATION:
NAME;Ce%A%LA IVDW0l.J/&rSF NAME: F $IAT"t
MAILING ADDRESS: RfS MAILING ADDRESS: 0 R
CRY:POV 4SQ0 STATE:L[F]_M O CTTY:Light Na.O r.Ae STATE:LIM Z�: -M5
PHONE41: SA)A •ACl'C SG9 / PHONE: CELL:
PHONEN2:�'�,ty� ti0 N71 EMAIL,:MD�LC TRANS PORK VAM00.
EMAIL: •E N0/ALFS a 0 ReEalrfs L&I REGNIL0.VSM.aIt_@SIC'
PRIMARY CONTA : OWNERg CONTRACTOR[] OTHER❑ ,
NAM ArOy fA, IY/ SMAIJr
MAILING ADDRESS 9�N/�N QUD � RD C STATE ZIP ��
PHONE�9��y s'A7/ CELL 30L- tt3A MD20
PARCEL INFORMATION: c/ FE 215 ZQTS
PARCEL NUAINER(12 Digit NumEw) �.a�L7'SI— 000.3 /J MINING 2
LEGAL DESCRIPTION(Abb Nthd)+awn0 .ns�: ii9 TIL 34/ FIRE DISTRICT RECEIVED
SITEADDRESSIIC.I r, LALLa SNn cDYAHeLTGYJ LIA
DIRECTIONS TO SITE ADDRESS I/Is[�7 aV 7D E &&d ingI " VIA) Q(4!/' T'
T O 6 .."ai.earili hot
IS THE PROIELTWITHIN M FT OF SLOPE(S)GREATER THAN 14%: YES[] NO,Q SNOWLOAD:Zg-,d
ISPROPEAT TYITHEi300FT0FTHEFOLI,DlMG:
SALTWATER D L.AKE❑ RIVEIUCT EEL❑ POND❑ WETLAND D SEASONAL RUNOFF❑ STREAM
TYPE OF WORK: NEw 16 ADDITION❑ ALTERATION❑ REPAIR❑ CTHER ❑
USE OF STRUCTURE Is—a-s Garage Geexvreiel M4F..) McSLo i—IjG L:
IS USE: PRIMARY SEASONAL[I NITMBEROFBEDROOMS`_NUMBER OF BATHROOMS_
HEATEDSMUCnTM YESreLa,AkWB YFSpW,]eRW❑ NO[]
DEscRIBEwCNUL"LJ -"A wFA:-7VRc0 R t wV LAt "P
SQUARE FOOTAGE:0,W)
1STFLOORfL1Qt{sq.ft 2NDFLOOR_eq.R 3RDFLOOR At.It. BASEMENT_y.ft
DECK_sq.R, COVEREDDECK_W.E. STORAGE aq.ft OTEIFR_sq.ft
GARAGE_sq.ft Aaachrd❑ Delac6M❑ CARPORT ,..B. Alfachd❑ Dracbed❑
MANUFACTURED HOME INFORMATION: e4 COPIES OF THIN FLOOR PLAN REQUIRED-
MAKE �a1R�t/P(�tiI MODELrR ' &I YEAR_2eiX_T LENGTH_T.,;t__
WmTH_J_BEDROOMS __ RATES SERIALNUMBER
FtwiRONMFNTAL HEALTH: r,�/
SEWAGE/SEWER SOURCE: SEPi SEWER❑ / NEFV]G EXISTING❑
PLUMBING IN STRUCTIRE? YES R NO[] IJyve.attach comPlwed WwerAda Wz,Fv m
PERUI:TER/FOUNDATION DRAINS PROPOSED? YES❑ NOS EXISTINGSQ.FT.
EXISTING BEDROOMS PROPOSEDBEDROOMS 0 TOTAL BEDROOMS
CANNER eWCMMputlM lalWasbn W Inaccumle IWmnetlon mry he"N 0aW vM We'w ea—h ha'—bn.PrMnMM)em<M o(Wit"ty
at,..bMx.I exfrt lM I.Ina vane,and 1 NlMer ease.thal l an,WNW to hesi Me ea-h aed le M Ne'wM1®popa W l Kva
ee,sW pmmWlw Marian as,mwmry pi lnduding em/ewmam M1dEs or WMN dinWeN tryaNinp tMa pmlel The erne+or lotted
rt%esematlro.Tapestries Mat Me mmih, ti n praNEN is W.Mas We emb wngareea al Maven Cwnty aveu b the Weis aessei Witi
andehiMeetalfamWewendlnseactim. This parity glntlwR Id wlgiicad kvMnmaM eaNuctlwlendmnmemNvtlhil lM
i Jaye rX�aWdan wak®eugmdN fora penpd al1B011eys.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY Of THIS
1 PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
( COUNTY CODE 14.08.42) _
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awte dOWNER(Must be alanatl by the OWNERI Dale
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TACSANOTEBICONDTTIDNB
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIREMARSHAL
PUBLIC HEALTH
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