HomeMy WebLinkAboutBLD2022-01459 - BLD CD Environmental Health Review - 11/15/2022 4.,' 0;•Pt44,4,c MASON COUNTY COMMUNITY SERVICES Permit No: €2L•Qv')�2.2--0l 57
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BUILDING PERMIT APPLICATION lder Street ) 2
PROPERTY OWNER INFORMATION: CONTIIACTOR INFORMATION: l
NAME:Williams Larry and Chris NAME:travis Rowland
MAILING ADDRESS:1301 harbor ave sw#110 MAILING ADDRESS:1091 se craig rd
CITY:Seattle STATE:`"a ZIP:98116 CITY:Shelton STATE:v'a ZIP:96584
PHONE#1:206-696-8664 PHONE: CELL: 360-870-1287
PHONE#2: EMAIL;travis@foxheadconstruction.com
EmAIL:22clwilliams@gmail.com L&I REG#foxhehc943ke EXP.04/$0/22
PRIMARY CONTACT: OWNER 0 CONTRACTOR 9 OTHER 0
NAME inwis'v.I" EMAIL travis@foxheadconstruction.corn
MAILING ADDRESS 1091 se craig rd CITY she&tal STATE wa ZIP98584
PHONE CELL 360470-1267
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 221272390070 ZONING
LEGAL DESCRIPTION(Abbreviated)TR 7 OF GOVT LOT 6&TAX 63C-2 TR A d PRTN OF B OF SP#113 FIRE DISTRICT
SITE ADDRESS 1101 krabbenhoft rd se CITY grapeview
DIRECTIONS TO SITE ADDRESS n on hwy 3,rt on krabbenhoft,stay right on krabbenhoft follow to end of rd by water
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO 0 SNOW LOAD: psf
IS PROPERTY WITHIN 200 FT OF TIIE FOLLOWING: (Check all that apply):
SALTWATER 8 LAKE 0 RIVER/CREEK 0 POND 0 WETLAND❑ SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW 0 ADDITION 0 ALTERATION 0 REPAIR 0 OTHER 0
USE OF STRUCTURE(Residence.Garage,Commercial Bldg,Etc.)residence
IS USE: PRIMARY 0 SEASONAL 0 NUMBER OF BEDROOM 5 NUMBER OF BATHROOMS3
HEATED STRUCTURE? YES(Whole Bldg)❑•' YES(Partlsl of Bldg)0 NO 0
DESCRIBE WORK new single family residence to replace existing home
SQUARE FOOTAGE:(proposed)
1ST FLOOR1700 sq.ft. 2ND FLOOR98 sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECKS sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft. Attached 0 Detached 0 CARPORT sq.ft Attached 0 Detached 0
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 0 SEWER 0 / NEW 0 EXISTING 0
PLUMBING IN STRUCTURE? YES 0 NO❑ IJyes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NO❑ EXISTING SQ.FT.
EXISTING BEDROOMS_3 PROPOSED BEDROOMS 5 TOTAL BEDROOMS
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 pr000sed.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 structure(s)for review and inspection. This permit/application 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 APPL N OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
X .7 11/7/22
Signature of OWNER(Must be signed by the OWNER) Date
EPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
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