HomeMy WebLinkAboutBLD2022-01221 - BLD CD Environmental Health Review - 9/15/2022 MASON COUNTY COMMUNITY SERVICES
Permit No:blinAg " 01 9�
m° Lc" PERMIT ASSISTANCE CENTER:
7< •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL RECEIVED
ell
• 0 615 W.Alder Street,Shelton,WA 98584 •
Y� .."— ' jA; Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone SEP 5 2022
t� ' BeIfair.(360)275-4467•Phone Elma:(360)482-5269
j`i"',•,,i:,,A-
BUILDING PERMIT APPLICATION 615 W. Alder Streety
PROPERTY OWNER INFORMATION:
CONTRACTOR INFORMATION:
NAME: FRED AND KATHY KOHOUT MAILING ADDRESS:
MAILING ADDRESS:460 ATE:WA ZIP:98_ CITY:
STATE: ZIP:
CITY:Olympia PHONE: CELL
PHONE#1: 14258024818 EMAIL : EXP. �
PHONE fred.k 575t m L&I REG#
EMAIL:fred.kohout mail.com OTHER❑
OWNER 0 CONTRACTOR❑
PRIMARY CONTACT: EMAIL STATE ZIPS
NAME CITY
MAILING ADDRESS CELL
PHONE
PARCEL INFORMATION: ZONING RR2.5
PARCEL NUMBER(12 Digit Number) 42213-23-70840
LEGAL DESCRIPTION(Abbreviated) N1/2 TAX 1084 EX S1/2 N1/2&S 100'OF N 3/57 CHS CITYHO STRICT T
SITE ADDRESS 23740 N. HWY 101
DIRECTIONS TO SITE ADDRESS •
FROM SHELTON,TAKE HWY 101 N SITE IS ON THE RIGHT AFTER PASSING
N.CEDARDALE NO❑ SNOW LOAD:25--Psf
N.
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 1 STREAM 0
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check ETthat Dy� SEASONAL RUNOFF 0
SALTWATER 0 LAKE❑ RIVER/CREEK❑ REPLACEMENT
TYPE OF E WO ; NEW 0 ADDITION ❑
ALTERATION ❑ REPAIR 0 OTHER ❑
USE OF STRUCTURE(Residence,Garage,CommerciaNUERESIDENCE
R OF BEDROOM NUMBER OF BATHROOMS 3
IS USE: PRIMARY 0 SEASONAL 0 N ❑
HEATED STRUCTURE? YES(Whole Bldg) 0 YES(Pails]of Bldg) ❑
DESCRIBE WORK
Remove and re lace existin residence and deck. Re air existin rock revetment.
SQUARE FOOTAGE: (proposed)
__
1ST FLOOR 1737 sq.ft. 2ND FLOOR 630 _sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
__ ft OTHER _sq. ft.
COVERED DECK 168 _sq.ft. STORAGE��_sq.
DECK 459—sq. ft. CARPORT__sq.ft. Attached❑ Detached❑
GARAGE sq.ft. Attached❑ Detached❑
*4 COPIES OF THE FLOOR PLAN REQUIRED*
'1p��F�CTtTRFn HOME INFORMATION: LENGTH
MODEL ...UAL.MAKE SERIAL NUMBER_ -�
WIDTH
BEDROOMS BATHS
ENVIRONMENTAL HEALTH: SEWER❑ / NEW EXISTING❑
YES 0
SEWAGE/SEWER SOURCE: SEPTIC 0 Form
NO❑ If yes, attach completed Water Adequacy
PLUMBING IN STRUCTURE?
PERIMETER/FOUNDATION DRAINS PROPOSED? NO EXISTING SQ.Ff.
PPROPOSED BEDROOMS
S � TOTAL BEDROOMS
PRO
EXISTING BEDROOMS 2__- work order or permit revocation.Acknowledgement of such is by
OWNER acknowledges I declare
a that
Iam wof inaccurateer andI information may result in a top
including any easement holder or parties of interest regaradinngg this
project.
The owner
or
property
' nature below.I declare that I am the owner and furtherc declare that I am entitled to receive this permit and to do the work as proposed. have
ccess
Sig
obtained permission from all the necessary parties,i 9
lication becomes null&void if work or authorized construction is not commenced within 180
representative, for
ntthat inspection.ns ie Th provided is accurate becomes
nod grants employees of Mason
and structure(s)for review and This permiUapp
days or if construction work is suspended for a period of 180 days.
ON
INAC
TY
PROOF OF CON
TINUATION OF WORK ON THIS PERMIT IS BY MEA S OF INSPECCATION TIO . EXCTIVI (M OF
THIS
PERMIT APPLICATION OF. 180 DAYS OF MORE WILL COUNTY CODE 4.08.42)
Date
DEPARTMENTAL REVIEW
X
Signature o AG NT.
APPROVED DATE DENIED DATE TAGS/NOTES/CONDITION
S
BUILDING DEPARTMENT IIIINIIIIIIIMIIINM
PLANNING DEPARTMENT IIIIIIIIIMIIIIMINIIIIININIIIIIIIIIIIII
FIRE MARSHAL • AIIIIM11111111111111 (,°YS' ,1 R��
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