HomeMy WebLinkAboutBLD2024-00258 - BLD CD Environmental Health Review - 2/29/2024 ENVIRONMENTAlititNo:i�1 'a(nay
MASON COUNTY HEALTH p02,.'a
COMMUNITY DEVELOPMENT
0 Permit Assistance Center, Building,Planning RECEIVE C
BUILDING PERMIT APPLICATION FEB 29 2024 s yZy
o 'y
PROPERTY OWNER INFORMATION• CONTRACTOR INgQ 'Fi wI Street 6 d
NAME:Jed Curtis NAME:Cameron Damskov
MAILING ADDRESS:50 E. Buckingham Ln. MAILING ADDRESS: 1940 124th Ave. NE, te. A 07
CITY:Grapeview STATE:WA Zlla:98546 CITY:Bellevue STATE:WA ZIP:98005
PHONE#1:425-753-1300 PHONE:425-454-8059 CELL:
PHONE#2:425-557-2680 EMAIL:cameron@damskovcons[ruction.com
EMAII.:jedcurtis@gmail.com L&I REG#DAMSKCL877DN EXp, 0 /06/25
PRIMARY CONTACT: OWNER❑ CONTRACTOR❑ OTHER❑
NAME Len Williams Williams Architecture EMAIL ten Wwilliams-architecture com
MAILING ADDRESS PO BOX 102 CITY SHELTON - STATE WA ZIP 98584
PHONE 360-426-0511 CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 12108-11-90012 ZONING RR5
LEGAL DESCRIPTION(Abbreviated) LOT2 OF SP#3150 AF#218565 FIRE DISTRICT
sITEADDREss50 E. BUCKINGHAM LN. CITYGRAPEVIEW
DIRECTIONS TO SITE ADDRESS TAKE WA-3 N. RIGHT ONE. GRAPEVIEW LOOP RD.
STREIGHT ON E. ECKERT RD. CONTINUE ON BUCKINGHAM LN SITE IS ON RIGHT
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NO j] SNOW LOAD:25_psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Cheri all thatoppty):
SALTWATER j] LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM
TYPE OF WORK: NEW EI ADDITION❑ ALTERATION❑ REPAIR❑ OTHER [ REPLACEMENT
USE OF STRUCTURE(Rrrideme,Cnmge,Commoelal Bldg,Etc)RESIDENCE
ISUSE: PRIMARY E] SEASONAL❑ NUMBER OF BEDROOMS 4 NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(WholeBkW❑ YES(Ron(s)ofeldg)E' NO
DESCRIBE WORK CONSTRUCT NEW RESIDENCE TO REPLACE EXISTING
SQUARE FOOTAGE: (pmpored)
1ST FLOOR 3677 sq.tL 2ND FLOOR 1067 sq.ft 3RD FLOOR sq.ft. BASEMENT sq,ft.
DECK 76 sq. ft. COVERED DECK 80 sq.ft. STORAGE sq.ft. OTHER 70 sq.ft.
GARAGE 376 sq.ft. Attached E. Detached❑ CARPORT sq.ft. Attached❑ Detached❑
VMqyrAew4RxjLnoME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC 'l SEWER❑ / NEW E EXISTING❑
PLUMBING IN STRUCTURE? YES 2 NO ❑ Ijyes,attach completed Wafer Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES E+ NO[] EXISTING SQ.FT.
EXISTING BEDROOMS 3 PROPOSED BEDROOMS 4 TOTAL BEDROOMS 4
OWNER acknowledges that sulanlsslon of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by
signature below.I dedam Mat 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 i mjact. The owner or legal
representative,represents that Me information provided is accurate and grants employees of Mason County access to the above described property
and structure(s)for review and inspection. This permNapplication becomes null&void if work or authorized construction is not commenced within 180
days or it construction w 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
C UNTY CODE 14.08.42)
X 2-29-24
Signature agent Dale
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS(NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH g b f S
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