HomeMy WebLinkAboutBLD2024-00265 - BLD CD Environmental Health Review - 3/4/2024 ® MASON COUNTY COMMUNITY SERVICES Permit No: 151J ,2D a/-I -W2.itP5j
\ PERMIT ASSISTANCE CENTER: RECEIVED
BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
615 W.Aider Street,Shelton,WA 98584
' Phcne Shelton:(360)427-9670 exL 352•Fax:(360)427-7798 Phone FEB 2 9 2024
Bel/eln(380)275d467•Phone Elma:(360)482-5269
BUILDING PERMIT APPLICATION 615 W. Alder t
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION
NAME:Kevin&Toni Bouwman NAME: m
z
MAILING ADDRESS:PO Box 354 - MAILING ADDRESS:
CITY:Hoodsporl STATE:WA ZIP:98548 CITY: - STATE:
PHONE#1:425-444-7832 PHONE: CELL:
PHONE#2:425-344-8412 EMAIL :
EMAIL:kbomman@llve.com L&I REG# EX .->
PRIMARY CONTACT: OWNER❑+ CONTRACTOR❑ OTHER❑ =�
NAME EMAIL MAILING ADDRESS CITY STATE ZIP
PHONE CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 4U09-64-0010 ZONING RR5
LEGAL DESCRIPTION(Abbreviated) Lake Cushman#17 Lot m FIRE DISTRICT 18
SITE ADDRESS 251 N.lake View Dr. CITY Hocdsport
DIRECTIONS TO SITE ADDRESS From Shelton We 101 Nplh to Hoodsport.In Hoodsporttake a left on Lake Cushman Road.Fellow uphill to Lake
Cushman God Course-take a left.Take a left on NE Fairway Dr.Fellow,to N lake Marx Dr.,251 will be an the left.
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑i NO❑ SNOW LOAD:55 psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: ICheckausharapPlyJ:
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW E] ADDITION ❑ ALTERATION ❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Beadress.Garage,Coam er sal Bldg.Eta.)Residence
IS USE: PRIMARY❑ SEASONAL ❑ NUMBER OF BEDROOMS 2 NUMBER OF B%A�TTH ROOMS 14
HEATED STRUCTURE? YES(Whsfe B/dg1 ❑ YES(Part(ul gl8W [] NO❑ /T. I YUO6•h�t'•Ltu
DESCRIBE WORK 111AA f fife -T)W7r-YylP4+* 1a)I.Q_l__'be, htlit_I l c°G�.. h,�'IIfW We ILILI L ./
SOUARE FOOTAGE: (Prigsaust)
I ST FLOOR 1224 sq. ft. 2ND FLOOR407 sq.ft. 3RD FLOOR sq.ft. BASEMENT 832 sq.ft.
DECK sq.ft. COVERED DECK 32o sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft. Attached❑ Detached❑ CARPORT sq.ft. Attached❑ Detached❑
MANUFAC l HOME INFORMATI *4 COPIES OF THE FLOOR PLAN REQUIRED*
M MODEL LENGTH
IDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGEISEWER SOURCE: SEPTIC❑+ SEWER❑ / NEW EXISTING ❑+
PLUMBING IN STRUCTURE? YES ❑+ NO❑ II yes, attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES y'�'P/ NO - EXISTING SQ.Fr.T
EXISTING BEDROOMS PROPOSED BEDROOMS 2 TOTAL BEDROOMS 2 r�
OWNER acknowledges that submission of inaccurate information may result in a 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 information provided is accurate and grants employees of Mason County access to the above described property
and structum(s)for review and inspection. This pannldapplicagon becomes null&void if work or aulhorbed construction is not commenced within 180
days or if construction work is suspended for a period of 1 BO 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)
X 0- aft - c4
(—ISIgnsfirl OWNER(Must be signed by the OWNER? Date
DEP TMMI'AL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL "�,� ,/•�,� }
PUBLIC HEALTH
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