Loading...
HomeMy WebLinkAboutCOM2011-00057 Expand Rx Waiting Room - COM Application - 7/12/2011 MASON COUNTY PERMIT NO. I..LJ i 1 LCJ� BUILDING PERMIT APPLICATION 426 W. Cedar• P.O. Box 186, Shelton,WA 98W Shelton (360)427-9670-Belfair(360)275-4467•Eima(360)482-5269 On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner Company Name Ild M • Mailing Address City tatef&_&_Zip Code CtlY to Zip Code QZOthor Ph. Phone Other Ph. Liens Title Holder Contractor Reg.# iS E mail address d E Mail Address�bOYl.i✓la S 7oRES lU�, I/t-�G Drivers Lic.# DOB 0 Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATION-Connect tQQ Ne So tic Existing Sept Connect to Water System Name of Water System s„ V. Well Water System Name of Water System PARCEL INFORMATION-12 Digit Parcel No -ZZ _ ~ 'Fire District Legal Description Site Address(Please include street name,street number and city) Directions to site Will timber be cut and solo in parcel preparation?Yes Ep Is property within 2W of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% Is ft=1 4submittal the result of a Stop Work Notice,Correction Notice or other er>foroerrtent adlion?YW" TYPE New Add Alt {�Repair Other PRIMARY RE SID ,E SEASONAL ❑ Use of Describe Work.,87. No.of Bedrooms No.of Bathrooms _L_—Square Footage-1st Floor— nd Floor 3rd Floor Basement Deck Covered Deck Other Sq.ft Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION -Make Model Year Length Width Serial No. No.of Bedrooms No.of Bathrooms Type of Heat Purchase Price$ Replacement Unit? Yes/No Installer Nam Certification No. OVOIER/BUILDER Ackmiledges subrnission of inaccurate irdomiation may result in a stop wok order or permit revocation.Act of such is by sigrehire below I declare that I am the owner,owners legal representative,or the contractor.I fwtw declare that I am erditled to receive this pernift and to do to wok as proposed in the application.I declare tat I have obtained the porn ission from all the neoessary parties.if perrrrission is ` required from any easement holder or an th y ot1w party in interest regar&ig is appki alion or the work proposed in the appliralton,I have obtained perrrmission from them to apply for this perrNt and oondxt the work proposed. The owner or agant on owners behalf,represents fed the rdorrnadion provided is aomde and grants employees of Mason County wows to the above desambed property and structure for review and inspection. OF CONTimo ION OF IS BY MEANS A q�SPECTION. X vi to 07/Iz/�i /owners R /Contractor in which one FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW A ROVED DENIED NOTES Building Department Planning Department Environmental Health Department Public Works Department Fire Marshal FEES Building Permit Fee Sftelnspecdon Plan Review Fee EH Review Fee Plumbing&Base Fee Planning Review Fee Mechanical&Base fee Other Wood/Gas/Pellet Stove Fee State BeF Violation Fee Pre-Paid at Submittal Valuation$ TOTAL FEES MASON COUNTY PERMIT NO. IYI Z61 BUILDING PERMIT APPLICATION 6008+ 426 W. Cedar•P.O. Box 186, Shelton,WA 98584 Shelton (360)427-9670•Belfair(360)275-4467•Elma(360)482-52�9 On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION OwneF Company Name Maifin Add Mailing Address 6 City Zip Code — CtiY State Zip Codeftl Phone or Ph. Phone Other Ph. Lien/Titie Holder Contractor Reg.# E mail address E Mail Address£b0 IIUG-_ Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATION-Connect IQ Ne Septi Existing Septic Connect to Water System Name of Water System Well Water System Name of Water System PARCEL FORMA 12 Digit Parcel No 'Fire District Legal Description Site Address(Please include street name,street number and city) �✓- Directions to site Will timber be cut and sold in parcel preparation?Yes o Is property within 200'of Saltwater Lake River/Creek Pond Wetland SeasonW.Runoff Stream Slopes or Bluffs > 15% is this ff submKW!%a;;;tdt.of a Stop Work Notice,Correction Notice or other enforcement action?Yee No TYPE OF JOB-NewT Add AltK Repair Other ,PRIMARY RESID E SEASONAL ❑ Use of Buildin 2 Describe Wo No.of Bedrooms No.of Bathrooms_ Z Square Footage-1 st Floor _Ad Floor 3rd Floor Basement Deck Covered Deck Other-Sq.ft. Garage Attas=^r, Detached Carport Attached Detached MANUFACTURED HONE INFORMATION -Make Model Year Length Width Serial No. No.of Bedrooms No.of Bathrooms Type of Heat Purchase Price$ Replacement Unit? Yes/No Installer Name Certification No. 0VW*F1/BU11_DER Aclvhowledges subrrrssion of inaccurate information may result in a stop work order or permit revocation.Adcowledgement of such is by signatue below.I decline that I am ft owner,owners legal representative,or the contractor.I hirther declare tturt I am entitled to receive Ctrs pemhR and to do the work as proposed in the applicator.I declare that I have obtained the permission from all ft necessary parties.If pemrssion is required from any easement holder or any other party in interest regar&V this application or the work proposed in the appkaft%I have obtained pemru�ionfrom them to apply for this permit and conduct ft work proposed. The owner or agent on owners behalf,represents that the rrdorrnaton Provided is accurate and granis employees of Mason County access to the above described property and structure for review and inspection. PR9MC!FC0NTINIJ OF IS BY MEANS A INSPECTION. to16— Owner/Owners /Contractor iIM e which one FOR OFFICIAL USE i rOND THIS POINT Accepted by: 'rWDate DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department Public Works Department Fire Marshal FEES Building Permit Fee Site Ins ection Plan Review Fee EH Review Fee Plumbing&Base Fee Planning Review Fee Mechanical&Base fee Other Wood/Gas/Pellet Stove Fee I I State Fee Violation Fee Pre-Paid at Submittal Valuation$ TOTAL FEES COMMUNITY DEVELOPMENT ENVIRONMENTAL HEALTH REVIEW Mason County Public Health Official use only 415 N.6th Street Permit Number: com�tk-00cs PO Box 1666 Shelton,WA 98584 Date Received: Shelton: (360)427-9670, Ext.400 Amount Received b Beifair. (360)275- 467 Ext.400 Elma: (360)482-5269 Ext.400 Receipt Number _ Fax.(360)427-7787 Applicant Information . Type of Review Applicant& S-mer SawaES.&Date 0 Building Permit Mailing Address 0 New 0 Replacement 0 Commercial Building Permit City State Zip 0 New 0 Replacement i DaytimeP�7figther PhZo one 682� 33 Building/ ommercial Permi as 0 Tenant Review E-Mail Address 6a011ie, yj 5*M 64+M_ Z a` 0 Pre-Application Parcel Information 12-Digit Parcel Number — UAOD/0 4,PL4, 400 Site Address i E Y 8 6�e Streef Number Street Name City Type of Job /Uj-jX9rx, Please submit a scaled plot plan showing all existing and proposed Describe wgrl�Q [t�ltt y5` �R�— building, on-site sewage system, Number of Bedrooms and well. On-Site Sewage Information t. 0• S. s _, Water System Information 14 On-Site Septic System 0 New 2 Existing ) Plumbing in structure? Yes 0 No 0 Sewer Name of Sewer System ' If yes: Using an existing on-site septic system will require a current please submit a completed Water maintenance report and a Record Drawing (Asbuilt). Documents Adequacy Form. for both of these requirements may be on file with Mason County Public Health. Other requirements may apply. licant Signat re L�,ate Official use only Departmental Review Approved Denied Notes Water Adequacy On-site Sewage System �I Tenant Review Revision Revised 12/17/09 9D PERMIT NR, MASQN'COUNTY PLUMBIN N . WMI , 1PPUi ATION= � Cect�rr«: ' .66WI �r wA t +l Shelton( )4 ) TQ5 7 Elma.(WO)MI20-520 e w . CONTRACTOR.N Owner COMO r�Neese Mitrli Mailing c, c�_, fff City CRY �: ��� dip C�rd+� Stars' �+a�Mill . Phones._._ _ Otttet Ph Phorna LieN We Holder Contractpr Reg E mail a D&W It ' IMF (} 7 E Mail Address Drivers Lic. b is Drivel Lk.lI' I tt' SEPTIC INFOWATION-Cotiriedto.New Septic Existing Septic Connect to Sewer System'. , Name rf Sew 1PARCEL,1NM tom; t Na 120 - _ Y rue Obstrict Legal Mser" Site Address(Please Indud name,street nu r a d c" f '3A WA �- Directions tQ site, a Is properir vun 2ptf'abI`plater Lake River 1 Creek Pond TYPE'OF JOB--New„ Add Alter Repair Other Use of E3uilding Location of Fi:. n4s- I t . . end Floor Ca a Closet PLUM (540Wfilurnber ofea lie, IC AL Ut►M Type of Fixture Ain.of Fixtures EM Fuel..:*,llectrtc_LPG_Natural G Host:Pur V_ Toilets TyrteofUrir ' No ofi;lJnrts Et; Bathroom Sink Furrtarae Bath Tubs;- Hea0imps Showets Spdt Vera Fart Water Heater PropaneTarsc Clothes Washer � 1 G Kith erl Sinks sip"SteA+e Dishwrasher KKhdten F=t H ood Hosebibs IZ DryerVeht Other µ Other Bass Fee OTAL 'L AL M ICAL OIM+ER %k"*dn of irra=*Mq inkansom nVW result in a atop watt akder or pmot vacaft.�rir�Aarlgerrient d' such is by algn k*i thal l sm awnw,�owners legal , .trr ttte aortFrastor.J furttierdecsne Utat l rMn eridlled io oeoeive this perrnrt aecito clothe wok aB propoeed.xi lire�lppir�on'.i dedsr8 ttrat 1 have otrtal�eitihe p�irrriissiori"tram all the�p M pemriaeion� mired#orn arry easerrrerit holder or arty aitrer interest nepardrlgttds or the wok pgiosed in ttae appirsr><,t twarve Lied parm�rcnewntosppA�for'tt�pennft�-nautdvct�waicpopa�d nkagerit�xt+�wrisrstehalf,rir�ntstftaltfte-�brrr�ior� provided a ac dte Kid 4*M"Oorxity mess to the oto ileac ed prnp ty and s for rei$ew`arid kisflectiat PHOIyF t5myMO)VOCIFAPFtQt ' o�tWI } 0wrtem kepresenrsuve leo*aetor (hckOe WWh orb) FOR OFFICIAL USE BEYOND THIS POINT'. Accepted by; Planning Pd Ck# Date M Ptf Recsot No DEPARTMENTAL-REVIEW APPROVED DENIED NOTES Building Department Occ Grow—Type Cqn—str. Planning Depampept Environmental Health Department FEES P,tumbft&Base Fee Site Inspection Mechanical&ease fee UFC Plan flevlew Fee Wood/Gas J Pellet Stove Fee Other Violation Fee. TOTAL FEES SAFEW, AY CIT, July 7,2011 Attention: Plans Examiner Reference: Owner's agent authorization letter,In Store Services In Store Ser-vices is authorized to act as the owner's agent for all permitting,construction and inspections for the pharmacy remodel at the following Safeway store: Safeway 1571 23961 NE State Route 3 Belfair,WA 98528 Thank you, Safeway IIn . Steve Rya /r Project Manager Saiewm Inc Seattle Division 1121120 Avenue NE Bellevue.WA 98005-0990 i cnv, � g m tao m �' !� � � ^• � o_� CAI r ' X m G) o c a D y 0 (Ay r n 0 � 2 o W o D 7G m 0 -4 o N T! C 49 > Cl) rMZ tnm o m w Z O 0z -1 �I N co C S 0 ' Z W m Z y D a a =+ ° o ' N Z �k a— O ^_ a y N y 7 n Z Z l CO) 3 (D ( W3 --o 3 = c D tcaC'o mCO) g cpCD Z MQ `rt►r—�' n v w OD m -I -o n 'fl m cc o w 0 a z 0) 0Q) N m rn m D m � O f m n x 3 ' c v -n D OD m CO) -n m �° W (3) Z n _ a m o r. z * C fn W z o Z � 0 o mm co a � z CO) c _ o i G. m � � o o < Z m a m_ acn o g c m N C a n ~ 3 N p0p� � CA 3 G pic J a d m ZZ <D 3 O ° m p n 3 x A 3 C/) o W O's 'a o o m °, e ? o 0 d o r G) o 7 <D O O y TI 00 9 RL O o O O 0 =y O TI p� O �TI 7 m a ry a m .. .. Otnm N � (D o' fimm A rn ) cngq �' to � OD -4 -49 °, QD OD N CYN a V <D N V v N CA)rn Li N N K < < 80 ° O ' 0 _ c� =. CO v o xWs � � � xA � W� -* Q0o xv z a� o - 0 rr Nc - m DSi -• 0 -a m :P c coil �co 090 °° m �.aQ 5 7 o4i < Cal~ 3 0 --I O O m a o - 7 :6CO >m o Z D v _ < ° �o S . CL ° _ -� 3 ° O 0 w o v, v a z .� a O c cl o v; c coo n -�n 3 R0 xo �' cps 9c�D Dmo u0i .0�.� �1 MkO 0 (D C 8 , zmz w m M. -4 I w m � C L " m..2 � � Os 1 J 2. C- c c N of ai U 0 5 O — cn cD c0i (per 21 m O c 8 � M. 0 (00 o v 0 cnpm o 0 0 -• CL N m m � 0 O � D � -* � z0 � (D8 0 o_ � m m p (D m 8 3 (D m 0 c• n a0 -4D 0 > ° 0 �, o CA _ CD -0 XH 7 p ; $ D00 0 � ° ��_ (D 8 3 -0m0 N � 'w Qn > > 0 000rD- n 8 m ( a.a. * a 0 cc°ci mDf- w co� S ncnw of ?+ .� m v Cl)0 N -0 m p N O -0 0 v C CL p m n Cm pp N a n n� m D ONmom a0 JuD0 a � � � CO)c w dl 3v 8 m OZm o � = 8 a o oN 'i o Z � fJ N 0 . D v d = - = gym "' 0 � � = Dz 0 a _m 0 m m a cg � z � m DZv m a ,� Oc N w(o m = m -� cn 3 8 8 (D m � � - � a p x D O co 0 * S. * a -a 0 zz _ 3 w oco D w co D CD mm � 0 °' ' ' � m Em : : �° = �' m 0m OZ d o ? o co -0 0 o. = c � xc o rtc° v m m �'; '�� o A S co m Z a �. 8 ° m o W o -n 8 o � rD- (a C a_ CCD r n �n m 3 a n 7 O O A S !+ � � m T � m CD 0 _' N CO) 7 O� v O Cm 0 w :3 ° - - - n OnCL fn T a7 n > 0Z A Q O N o a O ((DD � 0 0 W p1 ;:I• m m m — ;w = CD* � b W V 3o 3o Z -4 � -4 m ce O 9 (D P P P P P p .► O rZ p_v ado p_ o 3 3 3 3 > ;3 ;3 > 7 v _I ic -0 a ° 6 mZ 0 3 � N rt m � p m � aoo (ArD r O — -, n a iv " fl s► w o c�D O c o� r o 8 0 m Zn : Z Q� a r > > a s O O X Z m � CCD co 0 o. S P 9n + + + + 0 ` 0 7 O G!S (000 v O M 3� m � 0 «. X53D x ID 00 o > � $ �-� m �,m cc�cc o08 °� 4 m 003 c�u o q n� cn —� -i -Zi U) (A rpm 0 A� CC 3 c O —. p X C- A W A con m n � �° Ws - c:R a cc m oZ o < -' o a ? — 2 -0Oo o �'o a a w In � < oS m � ,Q a o ( m (D .► a� o u, 3 �' � r. � S = � m �' 0 O Ou j o.��. �' O' = Mn3 _ o �.a� cO�p mCN,� � (n cr 00 c 3N •((_n < � _ a (o �c 0 Oca Y 03 .• .Zmr7 � �A ( N O C C. 1 O M yvvw HOC � 3 O � O m -, � (n N m so ° �oai = � Q 8 my $ C a c D 3 o2o o (Dof � � m ;7 M M 0 m 3 �. � m Cr (a . as mo, m Q o < K c 3 50) of (gip Cho X m C 0 g.g 7 `� C v O Ol m _ a '� = 0 O m 3� > > Ero o CL C m o D co o g�< m (C '� 0 Cl) amp 0 0 o � � c z 3 m a � a n � O vcp �y •< C ai �m C N N 7 N O: , Cam. o tQ w � OD A (n C z cyo �vi r > G7 v 0ao ? 08 M mr .y .N r ► D �vo (nCD CL c° o2 c 0u 0(D u�i z < o� cu c -, —I NC-i a' w = 3 D 0 3 4z AW .� yr z oa oCL � or" CD � � m (D OHO C � coo CA) C.°c 0. CD A o <c y (D s cn � Qm mom m •1 w�. T N (1) Cl) T G O N N W O �' N Z rtl -„ p v m '" m -o 0 o w ri Z O � Z p < O 00 m� _ o n 0Nw b � 0 Z 0 ca Z w � -n Dz n co ' aa ° z o -nom0 > v` aC 3 D � tn rnm - N � °' D co m � x .4 0 � w z W n �. � g O -. m c � O CO) m Qn o M a X 00 s a m m z � rnC y m Z C 'n' C .... O Nm EZpu Z CO) CO G m to �' g . Z - < Z RI CL� � a rLcn = � m r� G) low 9 :3. 3 � �+ O X ~ �_ O '� a u W 0 g —' ic m a - m z o 8 00 w ay 3 m ' ©m.-34 Z vW m 67 9 3 Q co O R �— m rn `c = Cf) ^' C� 0 Cl m 5 �E oo Q _ � mmrllr � 40 QD 0 V 69 I i . t O 0) V V V 01 � � < g 43 Xoon SOD Xj ootoo D *o up Xw -� 3o T 0 �-• .o b c mnr A c = D � Nx m c o _SON corer � v a► ;� � r' 2 y 3 r"roO ca o� � m 8 m -10Z Z P- m"D �Z CZ1� <0 0� .�° O O rn � c c O Z a y X Cj T fJ� nz a - 1 � 3 1 Tw N �FI F) G S m �� c p cn d X m g -45 cn 9 v, zm� rt � t_p0 _z 00 oe m z (D N > >' st v rnmm as ,2 k ODp _}an n'• C z> Co. m (A _ a $ m�rr- a, m g aao w ?i Zo c =can a.) �a m i a � = a 3 OI y m � O9 moo OZ s a O 3m m co >om ° ��, o oa o Z � D �cn Amy `° � z grn a -, Q c °1 d O- v �-.� 3 N y a -o�_ o to B cn O z-4 bi =' ro w b T m m {D — d � m =_ � x0p a a D �► B m V s s -0 o OZZ O c) -.q 00 z Z D c fl •Q $ �i h � rnmn W x O C� Om 0 fh Cho m g ° o c mC a� cc g a a -4 14 - m CD � 70 70 01 ,: -TL - J 3 3 3 3 3 D �. 3 3 3 �' 3i 333 Cz r -Q 808 c nD 0 ak 9 CD { Q � r d f17 O m PV b n ► >> r V c � z r � 0 �� m w O cr =�� 7 - � � J 8 N 7 i Vi q .Oww m C A �p a > > Q! w w O O N W "L10Q � Z mc�Dm O C� O � ar m m 0 a CAooCn G7 �,— c a c $ -o N o► H m 70 r °,_ _� »qx A4 lot .5- c -+ N Zrc) �g �-. ' vz 0 o m =r ? rn anN- o 1p ax 23 $ � � mo m Cr am r coo a Sag 00 (D3 0 ram , B•n." M 1 8 zON ga co' co) a 26 0 0 c of I`� O rn � � to owl m o Pt �o C7 OR 9m - b' D'� � 000 wow m. O O � to w � � •, 5 8� 0 �� 05 1 0 �i. @ a� N� 3. �p 3 m c a� O b Ol =h z y v c Q 3 m . 6 FEr 0L 7 ct �S a � O* » z y m na W Sr- m e D ., $ N 01 N r•� 0 a p O C vl N lu 7 = m = Co 3 (00 m w 0.0. CL ati O M M S 7 10 1