HomeMy WebLinkAboutBLD2025-00484 - BLD CD Environmental Health Review - 4/16/2025 Permit No: R_EcavE.1,-,14
r MASON COUNTY
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`' COMMUNITY DEVELOPMENT APR 14 2025
\fit I':' . Permit Assistance Center,Building,Planning
615 W.Alder Street
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: ft12",6e-.1( (mf NAME: LC</fkS NIOAv
MAILING ADDRESS:keaS UYlc itCl-- QR S J MAILING ADDRESS: Itog t4i11A lie-S tIQ
CTTY:Pt(Tj ORC14/A STATE:_t4 ZIP:Q (11 CITY: 1-[N(r41EA/ STATE: K.)A ZIP: 76492 7-70
PHONE#1: PHONE:3ect Silo u(( CELL: 'P�
PHONE#2: EMAIL: SILT M46 El 1 (rMA IL-.Cdf`�
EMAIL: L&I REG# I pTIJ CS I t p EXP.v t/aS/ 24)2 l.::
PRIMARY CONTACT: OWNER❑ CONTRACTOR E oTH R••pu_ O
s
NAME LU C4 3 rA)p(1 A`- EMAIL 'S C DE
-kV S GH9
MAILING ADDRESS I O"k 1 t4 ALV ST,106 CITY t-(�NPJ/FW STATE MJ ZIP9 LO L
PHONE as() R 5-11 (9 '('{ CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 7.:22Li-S WOOvq ZONING
LEGAL DESCRIPTIONO� (Abbreviated) FIRE DISTRICT
SITE ADDRESS tie 22 S E S 11t l F(Z T-F,„(dalawCITY ( 2i(-F (v
DIRECTIONS TO SITE ADDRESS VP N L_E,VT j n/iU R6 1 y IE 'A', a
U IJ (tt( (T S' f
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO Iii SNOW LOAD: nsf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER la LAKE 0 RIVER/CREEK 0 POND 0 WETLAND D SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW❑ ADDITION❑ ALTERATIONT la REPAIR 0 OTHER 0
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Elc.) R.Ii5 I-)G jJ C I
IS USE: PRIMARY 0 SEASONAL B. NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS I
HEATED STRUCTURE? YES(Whole Bldg)0 YES(Partial of Bldg)E} NO 0
DESCRIBE WORK R€41/444 4 tel c c F.1 1 kt-ni A OA Q M
SOUARE FOOTAGE:(praposec
1ST FLOOR sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft. Attached 0 Detached❑ CARPORT sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC Di SEWER 0 / NEW❑ EXISTING
PLUMBING IN STRUCTURE? YES 12 NO 0 If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NOE EXISTING SQ.FT.
EXISTING BEDROOMS '3 PROPOSED BEDROOMS 0 'TOTAL BEDROOMS 3
OWNER acknowledges that aubm'sslon of Inaccurate information may result Ina stop work order or permit revocation,Acknowledgement of such Is by
signature below.I declare that I am the owner and I further declare that I am entitled to receive this permit and to do the work as proposed.I have
obtained permission from all the necessary parties,Including any easement holder or parties of interest regarding this project The owner or legal
representative,represents that the Informet:on provided Is actuate and grants employees of Meson County access to the above described property
and structure(s)for review and inspection. This penniUapp lcatlon becomes null&void if work or authorized construction is not commenced within 180
days or if construction work is suspended for a period of 180 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
Xgp ✓ ()404. 2625
S nature of OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE:. DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL [� /yl ( / ���
PUBLIC HEALTH f i 5//tA C.�> c S ic4
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