HomeMy WebLinkAboutBLD2022-01561 - BLD CD Environmental Health Review - 10/26/2022 • • OoD°°�-P�1^t�t MASON COUNTY COMMUNITY SERVICES Permit No: �c'i �C'�' f
PERMIT ASSISTANCE CENTER:
' •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
I • o 615 W.Alder Street,Shelton,WA 98584 7�� Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone LC)�j`t Belfair:(360)275-4467•Phone Elme:(360)482-5269
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r BUILDING PERMIT APPLICATION
C1— PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:Housing Kitsap NAME: Sop\G. _
_4_ MAILING ADDRESS:2244 NW Bucklin Hill Rd MAILING ADDRESS:
- J CITY:Silverdale STATE:WA ZIP:98383 CITY: STATE: ZIP: m
PHONE#1:360-535-6134 PHONE: CELL: z
PHONE#2:360-S35.6138 EMAIL,:LtdEMAIL:NailD@housingkitsap.org L REG# EXP. / /
1 PRIMARY CONTACT: OWNER❑ CONTRACTOR El OTHER El _ ICJ
m o
--.1..._.) NAME Jo•'KMnp EMAIL klempj@housingkitsap.org
MAILING ADDRESS 2244 NW Bucklin Hill Rd CITY Silverdale STATE WA Tp98383 D z
PHONE 360.535613E CELL 360509-9208
PARCEL INFORMATION: ^ = m
\ v PARCEL NUMBER(12 Digit Number) I a 7 a0-r0'G-?po 9 ZONING R-1P Z
LEGAL DESCRIPTION(Abbreviated)Lakeland Village 10 LOT:21&VAC PTN Blackwell St adj. FIRE DISTRICT 'S••
SITE ADDRESS CITY Allyn m
DIRECTIONS TO SITE ADDRESS Si. bock N o 4 IF L4 k,,eJa es( 0 e- OK
LVECT cS) OC DF E LUI+tr£ELe+Ai4,mT STjV, AJ(yrt
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES NO❑+ SNOW LOAD:3n psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW❑ ADDITION❑ ALTERATION❑ REPAIR 0 OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Erc.)Single Family Residence
IS USE: PRIMARY 0 SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole Bldg)ITV-YES(Part(s]ofBldg)❑ NO❑
DESCRIBE WORK N 4 Li 6 Al i,4 la M>, (..f (?s 41114 v'( (
SQUARE FOOTAGE:(proposed)
1ST FLOOR 13 33 sq.II. 2ND FLOOR sq.ft. 3RD FLOOR i----sq.ft. BASEMENT — sq.ft.
DECK a sq.ft. COVERED DECK 1 $ sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE '-($7 sq.ft. Attached Er 0 CARPORT sq.ft. Attached❑ 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❑ SEWER lk"--- / NEW 0 EXISTINTG❑
PLUMBING IN STRUCTURE? YES 0 NO❑ I,fyes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 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 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)
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Signature of OWNER(Must be�igned by the OWNER) ate
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH iZe'r \11(?'5 04htk-cS Cf..CW
•
1 16 E, be.r hw - teLPE
?161262Z . O 5 'l
Michael Matloff 12220- 7009
E 92 Allyn Group 1 LOT 7 1333 PLAN
10' .---(_____. „As--.--__ L ./
5'
EBERHART LN 102'
mwater
run-off path
15' 6'Road Easement
20' `OS``_,
/ _• E80
/ /
95' // 28' .. —.--, /
/ 45' — /
/ . `—' /
/ 1333 sf SF 3 BDRM 14' \\ i
/ 2Bath2Car 25' DS 1I /
20' 46' DRIVEWAY 'S
I
5'
/ 88.25 24'
/ 95'/
/ O POWER /
Cr
/ — / ''I
52' GARAGE 1' WATER '"�c/1 w '
/ _ (\Y'
E 90 SEWER /
— 19' p' /
10' /� / 1=20
/ /
/ /
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/
102
EH APPROVED
Rhonda Thompson 01/06/2023 / .
E 80
Public water and sewer /