HomeMy WebLinkAboutBLD2022-01563 - BLD CD Environmental Health Review - 10/26/2022 es`'" `'`1, ,t^ MASON COUNTY COMMUNITY SERVICES Permit No:�I(J L)LZ "O ic3�J
7 PERMIT ASSISTANCE CENTER: / '1�
i`. •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL ({
I I - 615 W.Alder Street.Shelton,WA 98584 / `')
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-R_...... ,y Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone t
1.It Beltair:(360)275-4467•Phone Elms:(360)482-5269 {
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BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
`. NAME:Housing Kitsap NAME: 6 frn4.E
MAILING ADDRESS:2244 NW Bucklin Hill Rd MAILING ADDRESS:
7 CITY:Silverdale STATE:WA ZIP:98383 CITY: STATE: ZIP: t'T'1
PHONE#1:360-539-6134 PHONE: CELL: z
.�1 PHONE#2:36as3s-s1a8 EMAIL:
]... EMAIL:NailD@housingkitsap.org L&I REG# EXP. / /
PR PRIMARY CONTACT: EMAIL Idernej@housingsitsap.org
OWNER 0 CONTRACTOR❑ sg OTHER 0.org m 0
�J NAME �
MAILING ADDRESS 2244 NW Bucklin Hill Rd CITY SiMrdek STATE WA ZIP98383 > Z
PHONE 36°4354138 CELL 380'50942O8 r E
PARCEL INFORMATION: rT1
PARCEL NUMBER(12 Digit Number) I) O—c�—G( 007 ZONING R'1P Q -Z Z
LEGAL DESCRIPTION(Abbreviated)Lakeland Village 10 LOT:21&VAC PTN Blackwell St adj. FIRE DISTRICT S
SITE ADDRESS_ y I E buLha- 1-6'111 CITY Alb1 r
DIRECTIONS TO SITE ADDRESS )t InfvcI.— %V eE E.Lak.ies A ei Dr. a of &Gs i
siot JF O. L J Aeau.,r/Stal` .5f•N. — 4 II/et
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO 0 SNOW LOAD: 3il�psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER 0 LAKE 0 RIVER/CREEK 0 POND❑ WETLAND 0 SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: • NEW 0 ADDITION 0 ALTERATION 0 REPAIR 0 OTHER D
USE OF STRUCTURE(R5Oenee,Garage,Commercial Bldg•Ete.)Single Family Residence
IS USE: PRIMARY SEASONAL 0 NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS a2
HEATED STRUCTURE? YES(Whole Bldg)I YES(Palls]of Bldg)❑ NO 0
DESCRIBE WORK tides) 6,;.f4. Pilell:,Iti Res
SQUARE FOOTAGE:(proposed)
1ST FLOOR i 3' 3 sq.ft. 2ND FLOOR / sq.ft. 3RD FLOOR — sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK 15 sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE 4(57 sq.ft. Attached 0 Detached❑ 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 GK.' / NEW Q EXISTING❑
PLUMBING IN STRUCTURE? YES 0 NO 0 If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NO 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 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
COUNTY CODE 14.08.42)
> 1/6141e (iiii Signature of OWNER(Must be shine the OWNER) D to
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL r` `_ - � ,�n,Q
PUBLIC HEALTH (err 'hS.h 3 "`^""- �' +w1 �`.saaek
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