HomeMy WebLinkAboutBLD2024-00720 Foundation Repair - BLD Application - 10/8/2024 DocuSign Envelope ID..EFB60BBE-B789-4C69-A66D-890FE787AC4F permit No: 1.-- V UOIJ �ru
MASON COUNTY
COMMUNITY DEVELOPMENT VED
Permit Assistance Center,Building,Planning
BUILDING PERMIT APPLICATION JUN 10 4
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: Alder }
NAME:Kim&Konstantine Roumeliotis NAME:TerraFirma Foundation Systems fr et
MAILING ADDRESS:221 NE Mountain View Dr MAILING ADDRESS:10111 South Tacoma Way,bid.4
CITY:Tahuya STATE:WA ZIP:98588 CITY:Lakewood STATE:WA ZIP:98499
PHONE#1:253-221-8813 PHONE:886-486-7196 CELL:
PHONE#2: EMAIL: '
EMAIL: L&I REG#TERRAFR931LH EXP.
PRIMARY CONTACT: OWNER❑ CONTRACTOR ID OTHER❑
NAME Ashley Haney EMAIL Ashley.haney(a)floterrafirma.com
MAILING ADDRESS 13110 sw wall st CITY Tigard STATE Or ZIP97223
PHONE 971-205-5223 CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number)223195000002 ZONING
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT
SITE ADDRESS 221 NE Mountain View Dr CITYTahuya
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO® SNOW LOAD:_psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all hat apply):
SALTWATER❑ LAKE® RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW❑ ADDITION❑ ALTERATION❑ REPAIR® OTHER ❑
USE OF STRUCTURE(Residence,Garage.carnmerriai Bldg,Etc.)Residence
IS USE: PRIMARY❑ SEASONAL❑ NUMBER OF BEDROOMS 2 NUMBER OF BATHROOMS 1
HEATED STRUCTURE? YES(WholeBldgil❑ YES(Pawls/ojBldg)❑ NO❑
DESCRIBE WORKVoluntary underpinning using 4 helical piers
SQUARE FOOTAGE:(proposed)
I ST FLOOR900 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® 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❑ SEWER❑ / NEW❑ EXISTING JE
PLUMBING IN STRUCTURE? YES❑ NO❑ lfyes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NO[] EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 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 1 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 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 APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
o—SigKd br. COUNTY CODE 14.08.42)
kjyM t S 5/10/2024 1 11:49:49 AM PDT
cg �t a of OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT .�
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH