HomeMy WebLinkAboutBLD2023-00089 - BLD CD Environmental Health Review - 1/23/2023 ,,,o`'•'IA�N1 MASON COUNTY COMMUNITY SERVICES Permit No:"i'I(L 2 /?,)-W)f^I
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ERMITBUILDING ASSISTANCE•PLANNING•PUBLIC CENTER:HEALTH RECEIVED
�� •FIRE MARSHAL
w t� )• 7 615 W.Alder Street,Shelton,WA 98584
- -- y Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone0 (1/\ JAN 2 3 2023
),,. ,4�_• Belfair:(360)275-4467.Phone Elma:(360)482-5269
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lll.lw.,�, BUILDING PERMIT APPLICATIC 5 W. Alder Street •...
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: m '
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NAME:Megan Brown-Nydegger&Brett Nydegger NAME:Daniel MacMillan • r
MAILING ADDRESS:3052 42nd Ave.W. MAILING ADDRESS: = RI
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CITY:Seattle STATE:WA ZIP:98199 CITY: STATE: ZIP:
PHONE#1:Megan:206-939-0200 PHONE: CELL: ( j1011
PHONE#2:Brett:206-939-2200 EMAIL :golfmac1610@gmalI.com r
EMAIL:megan_nydegger@yahoo.com,brett.nydegger@gmail.com L&I REG* EXP. / /_
PRIMARY CONTACT: OWNER 0 CONTRACTOR❑ OTHER❑
NAME EMAIL
MAILING ADDRESS CITY STATE ZIP
PHONE CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 42307-50-00104 ZONING RR-5
LEGAL DESCRIPTION(Abbreviated) LAKE CUSHMAN#2 TR 104 FIRE DISTRICT
SITE ADDRESS 140 N Potlatch DR N Hoodsport WA 98548 CITY Hoodsport
DIRECTIONS TO SITE ADDRESS Hwy 101 N,L on N Lake Cushman Rd/Hwy 119,Stay L on N Lake Cushman Rd/Hwy 119,L on N Mt Tebo Way,
R on N Mt Church Dr,L on N Potlatch Dr,site is actually on left/Inland side of road.
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO D SNOW LOAD:55 psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
. SALTWATER❑ LAKE❑ RIVER/CREEK ❑ POND ❑ WETLAND❑ SEASONAL RUNOFF ❑ STREAM 0
TYPE OF WORK: NEW D ADDITION ❑ ALTERATION 0 REPAIR❑ OTHER 0
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc)Seasonal garage with SFR above
IS USE: PRIMARY ❑ SEASONAL 2 NUMBER OF BEDROOMS 2 NUMBER OF BATHROOMS 1
HEATED STRUCTURE? YES(Whole Bldg) ❑ YES(Part[s]of Bldg) D NO 0 -
DESCRIBE WORK Seasonal garage with SFR above
SQUARE FOOTAGE: (proposed)
1ST FLOOR sq.ft. 2ND FLOOR 987 sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK 40 sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft.
. GARAGE 1216 sq. ft. Attached El Detached❑ CARPORT sq.ft. Attached 0 Detached 0
MANUFACTURED HOME•INFO.RMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
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MAKE.-- MODEL --YEAR LENGTH
WR�'---
IDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC SEWER 0 / NEW ❑r EXISTING 0
PLUMBING IN STRUCTURE? YES ❑' NO ❑ Ifyes, attach completed Water AdequacyForm
1 PERIMETER/FOUNDATION DRAINS PROPOSED? YES Q NOD EXISTING SQ.FT. N/A EXISTING BEDROOMS N/A PROPOSED BEDROOMS 2 TOTAL BEDROOMS 2 —
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
1 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
j PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED. (MASON
COUNTY CODE 14.08.42)
Digitally signed by Rachel Weber 2/29/22
XRachel Weber Date:2022.12.29 10:12:52-08'00'
Signature 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 12 '7,‘�r '�A IS Ff b 1023 • (�/tri/ '/"dam n d 6act
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EH SETBACKS
A)Drainfield/Reserve requires 10'setback from footing/foundations
B)Septic tank(s)requires 5'setback from all footing/foundations
C)No foundation/perimeter drains within 30'down-gradient of drainfield/
reserve area
D)No cut(s),bank(s)(greater than 5'&over 45 degrees)within 50'
down-gradient of drainfield/reserve area
EH APPROVED
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f P4RCEL NO. 47301-5®•00104
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• e> StTE ADDRESS, u0 N POTLATCH DR NORTH
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