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CONCRETE MECHANICAL MANUFACTURED HOME Oa
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Dale By
le Footings l Setbacks Goa Piping Ribbons
0 Intenor Date By interior-Date By Date By
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Extwxo Date By Exterior-Date B
INSULATION set-up
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Point Load!Isolated Footings Date By n
BG I SLAB INSULATION ---- m
Data By Data By FIRE DEPARTMENT
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Foundatlon Wails Floors Date B.Y
Date By Data By DECKS —
FRAMING Walls Date By
Date By Data By PROPANETANKS
PLUMBING vault Date By _
Date By --- OTHER
Groundwork Attic
Date By I Type.
Date By _ Date By
D.w.b DRYWALL _ Type n
Int.Brace Wall Date, b,
Date BY I pale By FINAL INSPECTION N
Fire Se O
Water Line Pe ration �
Dale By Date By Date By Ca
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Pass or Request Inspect. O
Type of Insp. Fail Date Date Done By ! Comments N
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MASON COUNTY
CHANGE IN TENANT APPLICATION
Complete the Change in Tenant Application and return with a floor plan, site plan, septic pumper's report, septic records and
fee to the Mason County Permit Center, P.O. Box 186, Shelton,WA 98584. Evaluation of the Change in Tenant Application will involve
staff members from the Building, Fire Marshal, Environmental Health, Planning and Public Works offices who will identify compliance
requirements. This application is intended for tenant change only. If construction or remodeling is proposed or required a building
permit will be necessary. Upon approval the permit will be issued to the applicanUtenant. After the permit is issued, schedule an
inspection by calling(360)427-7262. Upon satisfactory inspection a Certificate of Occupancy will be issued and must be posted in a
conspicuous place on the premises.
PROPERTY INFORMATION
Date _ Assessor's Parcel Number: a - O
Legal Description: a0-4- ,- 3 ,O ,F,j�_D ,L1. LS
Building Site Address: 3
Method of sewage disposal: • Septic O Sewer- name of district:
Water source: • Individual Well O Community Well O Public System, name of system:
PEOPLE -INVOLVED IN THE PROJECT
Name of Applicant: aj -IrS Vr es
Mailing address:
City: State: Zip:
Day phone: Contact Person: Message phone:
PROJECT INFORMATION
Proposed business name: ,y. Y
Proposed use: i Number of employees:
Previous business name: Cj-r 5
Describe previous use: 5� }W\,(_
STRUCTURE DETAILS
Check one: • Detached single level/single tenant O Single level/ multi tenant
O Multi level/single tenant O Multi level/multi tenant
Age of structure: Is structure currently If not occupied, how long has it been vacant?
occupied? Yes No Yr. Mo.
Square footage: I Basement: I First: Mezzanine: Second: Third:
Is the structure heated? Heating type: Circle one: N L�
Circle one: Yes Electric Liquid Propane Natural Gas Oil
Type of heat: Circle one: Furnace Heat Pump Electric baseboard or wall mount Radiant
Will there be any changes to the following? Circle yes or no, if applicable:
Floor lay-out: Yes No Lighting: Yes Heating: Yes
Exterior Finishes: Yes Interior Finishes: Yes Parkin : Ye
Number of restrooms provided: Number off *ineachn�V xture
Is structure handicap accessible? Circle one Yes No
Is the structure equipped with a fire sprinkler system? Yes No Fire alarm system? Yes No
Monitoring Station Name: Phone number:
NOT BE ACCEPTED WITHOUT:
1. Floor Plan(5 sets): L
Draw the floor plan to scale �i►-1 � S Use of rooms
• Room Dimensions 1�� ocation of all exits and windows(include dimensions)
• Location of plumbingand mechanical fxtur s t nterior doors with swing radius
2. Site Plan(5 sets): Note scale used
• Property lines, easements, &right of ways • Location of all existing structures&dimensions
• Distance, in feet,from property line&structures • Landscape buffer yards
• On-site sewage tanks and drain fields, & reserve • Well location
• Location of fire hydrants&vehicle access roads 0 Parking areas number&arrangement)
3. Septic records,pumper's report or O&M report.
4. Fees will be collected at time of submittal
Official Use Only
Accepted 07M,224Dat Submittal Amount$ 9 Receipt number
De parturient Review ljm;ie �Yfe c.O^'m1 ntS
Building L
Environmental Health
Fire Marshal
Planning
Public Works
Occupancy Change? (circle one) Yesb Type of construction
Occupancy classification change from to Occupant load calculated: persons
Existing occupant load design persons. Land Use Designation:
Occupancy Classification: