HomeMy WebLinkAboutBLD2025-00204 - BLD CD Environmental Health Review - 3/17/2025 w 01D711E�CQD062 _ ,������0b�
MASON COUNTY PerroH No: //
COMMUNITY DEVELOPMENT ' CEIVED
Permit Assistance Center,Building,Planning FEB 19 [,OW
BUILDING PERMIT APPLICATION Street
PROPERTY OWNER INFORMATION: CONTRA CTORINFORMATIOR:
NAME:+^— NAME:ImPeb ---(—DMnva )
MAILING ADDRESS: MAILING ADDRESS:ro-1^nn
CITY: 1. STATE:w^ ZIP.amu CITY:"mnR°e STATE:N^ ZIP:vwo-lom
PHONERI:Msew4Ne PHON CELL; ---
PHONEg2: EMAI.:�`v✓• —
EMAIL:•.M+XQn^X^nm^ L&I REGkIxTEDxpLy1 EXP. 042126
PRIMARYCONTACP: OWNERQ CONTRACTORQi OMERRD ---
NAME rr.wl..Xy.abe.o. EMAIL�.m^
MMLINGADDRESS--tee^^^ CITY STATE r
PHONE CE
RMCrN ENTAIL
bo«,wl LL
PARCEL INFORMATION: H EA H
PARCELNUMBER(I2Dign Number) 4]BIMI1 f1B ZONING
LEGALDESCRIPHON(Abbrevimd) Lboe NTR112 FIRE DISTRICT IS
SIIE ADDRESS1�x�EA C[TY
DIRECDON$TOSGEADDRES$ �^ L> 'iXm1M:TunLoblYeCWnai xa;TunLmbN MdeeCNTp:TbnLMM /�
PobN u,Mhn.m Rdtl a
IS THE PR04KC3'WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESQi NO❑ SNOW LOAD. 9252025
T
M PROPERTY WTRIN1200 FT OFTHE FOLLOWING: Icn.aw�aPPry): B Z 5 20
SALTWATER❑ LAKED RIVER/CREEK❑ POND❑ WEILANDD SEASONALRUNOFF❑ S 1S
TYPE OF WORK, NEW p ADDITION❑ ALTERATION❑ REPAIR Q OTIffR II -tc vt0
USE OF STRUCDJRE(w.mxe[a,ge taine�x�Ek.)�^P�^^ber�+e^^^�mW�
ISUSE: PRIMARY[] SEASONALE] NUMBEROF BEDROOMS NUMBEROFBATHROOMS
HEATED STEUCDJRE1 YES/Haab B.w❑ YES EPm(+)vfBw❑ NO EI
DESCRIBE WORKR�ee�vepe.�eedFNmmsxu NNIN
SQUARE FOOTAGE:IPA
ISTFLOOR K,& 2ND MOOR sq,& 3RDFLOOR N,ft. BASEMENT K.8
DECK vl.& COVEREDDECK q.R STORAGE KI OTHER- LN.R
GARAGE_,ft. Afmc dO Dem o CARPORT q.R AuM d❑ Dcb hed❑
MANUFACTURED HOME INFORMATION: •4 COPIES OF THE FLOORPLAN REQUIRED`
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATH$ SEUM NUMBER
ENVIRONMENTAL HEALTH:
SEWAGESEWERSOURCE: SEPTIC Di SEWER / NEW❑ EXISTING El
PLUMBINOwsmUC Et, YFSD NOQ /fynu canphUd WN Ad F
PFRp1fE"IER/FOUNDATION DRAINS PROPOSED? YF 0 OD EXI$TNGSQFT.
EXISTING BEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS
OVMERaY^M Yn tlM pdrlivYpl pFb[pnblr(amWm^W�mul�Inem9raltaNwpOXmbmm•Jb�.IdnvxMf9emeMNa libty
pprebre Edox.I Eetlae N9l an tlbaxseblMN:htlaetlW lsn plWbNbleW.eeYe pemil mqb MtlnxMngcpnM.I Mw
aominm ceimiswnrmnali ma nasmar wlls,Y Jtlro bn eaanem MbavPaXnpknemelmNaa�amla Pq�. Tne was rclepel
leplesenlelxe lepeaaib Mel the inlwmM pmbeXbmlde ab pnnle miPb,2o MMmon CCunly BCpNb NBIMUB tl&%fiW ORWIJ
ene slulu2{flla reutex meinspttHm.TbPeml/ypFeMn Rr nnuA6wNXxaRaeNanzeO MfINC4M bnp MiVilencN wMilim
' earo aln�apNmoa wnmanlx++nm X,<.Fallm plm mro.
PROOF OF CONTINUATON 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 14MA2)
i t 12/3R024
A 'filRla�re&OWNER(Mustbaela WMe OMERI Dek
DEPARTMENTAL REVIEW APPROVED DATE DENIED I DATE f TAGSNOTES/COWITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
j FIREMARSHAL
PUBLICHRALTH (�
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