HomeMy WebLinkAboutBLD2022-01566 - BLD CD Environmental Health Review - 10/26/2022 „ C"1444121_ MASON COUNTY COMMUNITY SERVICES Permit No: e)) C1 20.2,- 'v I CD-(-01D
r o` PERMIT ASS/STANCE CENTER:
..• L •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
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'0 615 W.Alder Street,Shelton,WA 98584
k.f i Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone
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Belfair:(360)275-4467•Phone Elmer(360)482-5269
BUILDING PERMIT APPLICATION
\ PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:Housing Kitsap NAME: S#w C
MAILING ADDRESS: 2244 NW Bucklin Hill Rd MAILING ADDRESS:
CIZ-y:Silverdale STATE:t�A ZIP:98383 CITY: STATE: ZIP: rn
PHONE#1:36a535-613a PHONE: CELL: z
PHONE#2:360-535-6138 EMAIL:
EMAIL:NailD@housingkitsap.org L&I REG# EXP._/_/_
PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER 0 =
NAME""K""'P EMAIL klempj@housingkitsap.org
MAILING ADDRESS 2244 NW Bucklin Hill Rd CITY SiMar°'” STATE WA ZIp98383 D
PHONE 36o336E138 CELL 360-509.'268
PARCEL INFORMATION: Ei—
= rn
PARCEL NUMBER(12 Digit Number) / 32.C.2— '6 3 oO I ZONING R-1 P Z
LEGAL DESCRIPTION(Abbreviated) Lakeland Village 10 LOT:21&VAC PTN Blackwell St adj. FIRE DISTRICT S
.....` 0 SITE ADDRESS_ Z C. �sb[�ilJ1tt/L j- .L t o,1 L CITY Attyn
,�.? DIRECTIONS TO SITE ADDRESS % bInek N. oP F. Lak,ta'. ( 1)r'. a/V 1.1A-sr r
,,,(\ J/AE Cc E. 1.1 Ac•cJ.-r r.b w..f A 4. N. - 4//1- 4
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO Q SNOW LOAD:,3C,psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER 0 LAKE 0 RIVER/CREEK 0 POND 0 WETLAND 0 SEASONAL RUNOFF❑ STREAM 0
TYPE OF WORK: - NEW 9 ADDITION❑ ALTERATION 0 REPAIR❑ OTHER El
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.)Single Family Residence
IS USE: PRIMARY IIKIEASONAL 0 NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole Bldg) YES(Pants)of Bldg)0 NO 0
DESCRIBE WORK A l�e�. _�/�t�f•. •_Q. r� rL ti d�[►ECG
SQUARE FOOTAGE: (proposed)
I 1ST FLOOR(3 33 sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR ' sq.ft. BASEMENT / sq.ft.
DECK sq.ft. COVERED DECK 7 S sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE'/61 sq.ft. Attached[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 i.Il / NEW 9 EXISTING 0
PLUMBING IN STRUCTURE? YES 0 NO 0 If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES D NOD EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 3 TOTAL BEDROOMS 3
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 structure(s)for review and inspection. This permit/application becomes null&void it 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
COUNTY CODE 14.08.42)
X gd /C 4l/S lk,)-
Signature of OWNER(Must be sic; d by the OWNER) D to
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT 1"
FIRE MARSHAL ,, �J,Q
PUBLIC HEALTH 1� \ �(j(z r�` t1 '^3 ` -G t +n
Public water and sewer
EH APPROVED
Rhonda Thompson 01/06/2023
D1c.L p L - Q Ic.nLa
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2, . 'L.huv1 -I- LaoC
Karleen Franklin 12Q 3001
Allyn Group 1 LOT 11 1333 PLAN
E 102
10' \` 93'
/
/
/
a _,
75' / 34' E 94
/
1 FIN.FLR. 52' ;
5' / 99.00 /
/ / 5'
! !
/ /
/ 46' GARAGE / 7' SEWER
/ /
i 1333 SF 3 BDRM 21�� WATERe
�/! 2 Bath 2 Car oRc 2a A♦
1 +/
E 102 \`--. A
5' /
• 25' DRIVEWAY /
28' // 95'
►5 /
/ N
1,,
62.36' /
45' /
/
/
5' /
/
'S
/ 1=20
5' 1 /
/
20' ■ 5'Road Easement
10'
• EBERHARTLN
30.64' E 93
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