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HomeMy WebLinkAboutBLD2022-01565 - BLD CD Environmental Health Review - 10/26/2022 e��s"` ft,,,,,,,t^ MASON COUNTY COMMUNITY SERVICES Permit No: ~I j1c1 2-C 2 Z L�' Lr't2 • PERMIT ASSISTANCE CENTER: P` •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL •�I. •- 615 W.Alder Street,Shelton,WA 98584 I Gy f itf Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone o, c Bellair:(360)275-4467•Phone Elma:(360)482-52691-12) f. , 0 BUILDING PERMIT APPLICATION PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: NAME:Housing Kitsap NAME: c3f i'i.e �., MAILING ADDRESS:2244 NW Bucklin Hill Rd MAILING ADDRESS: m CITY:Silverdale STATE:WA ZIP:98383 CITY: STATE: ZIP: Z 4 PHONE#1:360-535-6134 PHONE: CELL: U PHONE#2:360-535-6138 EMAIL: EMAIL:NailD©housingkitsap.org L&I REG# EXP._/_/_ PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER B rn 0 NAME.wax."P EMAIL klempj@housingkitsap.org D Z • MAILING ADDRESS 2244 NW Bucklin Hill Rd CITY s""'"'• STATE WA ZIP98383 r ;.) PHONE 3eos3s-613e CELL -5o9-e208 r PARCEL INFORMATION: = z PARCEL NUMBER(12 Digit Number) 1 as aO^ OIL- L-(�I ZONING R-IP 1 LEGAL DESCRIPTIIOON(Abhre.,:�+•.t" Lakeland Villaoe 10 LOT:21&VAC PTN Blackwell St adj. FIRE DISTRICT 5 _ _� SITE ADDRESS_ �O b GtJ-((i hCL /b-i'1 ell: CITY Allyn r v11 DIRECTIONS TO SITE ADDRESS yi pi,oc,lc /X E.< E. L 6t kcJ a V1rQ l)r, d iv Gti k S i ,)• S i D e of e ZJA•t, k ,r i5 kt- Ste t( - 4!&(n IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES NO 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 0 STREAM❑ TYPE OF WORK: NEW 0 ADDITION 0 ALTERATION 0 REPAIR❑ OTHER B USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc)Single Family Residence IS USE: PRIMARY[[ EASONAL 0 NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS 3. HEATED STRUCTURE? YES(Whole Bldg)[V YES(Part[s]of Bldg)0 NO 0 DESCRIBE WORK N.e w 6 i,i 'L,L, Fa A't,e k1 i?es 14E$.CG- - SQUARE FOOTAGE:(proposed) I 1ST FLOOR f 33 sq.ft. 2ND FLOOR / sq.ft. 3RD FLOOR sq.ft. BASEMENT / sq.ft. DECK_ _sq.ft. COVERED DECK Z 6- sq.ft. STORAGE sq.ft. OTHER sq.ft. GARAGE L(S? sq.ft. Attached IV Detached 0 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(3"-...-- / NEW Q EXISTING❑ PLUMBING IN STRUCTURE? YES 0 NO❑ If yes,attach completed Water Adequacy Form PERIMETER/FOUNDATION DRAINS PROPOSED? YES B NOD EXISTING SQ.FT. EXISTING BEDROOMS PROPOSED BEDROOMS -3 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 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 0 COUNTY CODE 14.08.42) r a at.--� cik(d-vaa 1 a ure of OWNER(Must be signed by the OWNER) Da e DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT 0 FIRE MARSHAL PUBLIC HEALTH i 1 c,ii, GCS 1'n....,j c a 13 g 03 � D CD 3 v Nv m g3 0 con c 0 / CZ m // CCD w I Vt CCO CDD / 7 ' / -- "3 / / / — / / / / / / / / -Lri / / / / / N / / q I / I / 1 ' N N —% / / Co co ( o T • / / N (W N ? / / N TI 71 / /o 0 CA / CJ7 '/ • N N CA 1 o0 / 0 / A / n N / CO A i U1 . / 0 m /I! A C) ,� CD 73_ / / CP D 1/ 1 23 / D Er / C1 CD / (� N NI N y $ m j t 4 ii m N z —► C.A.) l O ` O �' { N z 41. P. CD { i 9 1