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SITE HAS A(1)STORY WOOD BLDG WITH BASEMENT AND PARKING TO REMAIN. to IS PARALLEL& BUSINESS NAME: LES SCHWAB TIRE CENTER ETAL BLDG. 2 A METAL BLDG.IS ALLOWED. TO THE NORTH ! ADDRESS 23090 NE SR 3, BLDG. P _ � 3. 20'LANDSCAPE BUFFER REQD.ABUTTING HWY.3 WITH PEDESTRIAN-omENTED lop 4F 16'E)286.76' I S66'491 6"E 286 78' BELFAIR. WA 98528 W/NO BASEMENT STREET FRONTAGE(1)TREE/30 L.F.&(1)SHRUB 120 S.F.OF FRONTAGE. . 4. MIN 9'X 20'PARKING STALL REQ'D. h h h 5. SITE IS LOCATED IN THE COUNTY. I I I 6. CROSS-ACCESS WITH THE PROPERTY TO THE NORTH OF THE SITE IS REQD. 949'18'E I Lp $ / 7. DUMPSTER PAD IS REQUIRED TO BE SCREENED WITH 6'HIGH WOOD FENCE . STORMWATER REQUIREMENTS MUST BE VERIFIED BY CONSULTING ENGINEER II /W V o, U I ROW LIE v 1 � � I I I I P2000' 30.ar 20.0o' = tv 26.ar SIGN NOTES: I I I I fig 32' I g 1. WILL A SIDE LOGO BE REQUIRED? I Ro O I I_ I 0 Reilly Auto Parts g g 2 MAX.MONUMENT SIGNAREA•32 S.F. cs� 3. MAX.MONUMENT SIGN HEIGHT-10'OAH i I WIDTH I PROP. 0 70'-0'X95'-0' i� 8 i I I 83 P.LINE PE t R SQ.FT.=6,650 05 " 4. SIGN SETBACK.'S'FROM RAN OR 12'FROM OHE LINE. EL f ^ / h n FLOOR EVATION:7 .Is � g I 5. MAX.WALL SIGNAGEAREA:WE CAN DO OUR 40'ALL CHANNELS I I I 15' NDSC a _ 1 I SE SR T / Jam{' a 15' l P VEMENTS - I i l ' ,l�•p5 I III 'r $Ld DEALER- D — t ' ('— —— DOOR_ !IIJ —D— - EGRESS s 8""Reilly AUTO PARTS IIC I + I Z' " WA. (BFR) PARKING BELFAIR III ' V ' J I I I 'T�..' w/L i . ' i i =-;•� g ' ..� `�.., • _( ' 26 SPACES k:'� cn PRELIM. SITE PLAN +2 HC vI NORTH III. ► III_ _•, , . ! • ., " --•�+ - ' -- r g pAQ ...;; DATE:June 21,2011 BPM =28 SPACES SCALE:1'=30'-0" 4 APPROVED II- �M,ASON COUN.Y DCD PLANNING gaing� I �"� srOW W� SUE PLAN REQUIRED TO BE ON SITE II i — I- I �� , BASEMENT`M°0D 151 6HANG S ET TO AP OVAL I I I I 1 ► _ `` r (31n G y \ Date 1-7 SALE 1C I I I I I I 8 li• O / ORAPPROX. END >�' I I I ' I "1 -'/ '•, OL OF EASEMENT a II I J 1A o �¢ 9OF 1 I I t> 1 f SCAPE 1 77— MMDW PROPERTY AI)fM40 NE WJ BffARWA MM PARCEIJ 50-OM 1 S I I t l III I u % e W MOBILE HMME NO BASELIENT II i I 7 BIJX PEAK EL=88.36'.FA.=n.50 I I I LINE§ I I_ I s zom (MU)Mm USE � wAu � fl I I RBI! I / I I 1 I I L GRAM I I � °N-STATE MASON COUNTY o Py A o N DEPARTMENT OF COMMUNITY DEVELOPMENT S N = Planning Division o Y y P O Box 279, Shelton, WA 98584 (360)427-9670 186A NOTIFICATION OF INCOMPLETE APPLICATION December 19, 2011 O'REILLY AUTOMOTIVE STORES INC 233 S PATTERSON SPRINGFIELD MO 65302 Parcel No.: 123325000942 Project Description: AUTO PARTS STORE Dear Applicant: You have submitted a permit application (case no. COM2011-00104) for proposed construction or development in the county. Upon review of your application, I have determined that the contents of the application are incomplete or do not provide enough detail for review. Therefore, review of your application will not proceed until the necessary information is provided (see the comment section of this letter for details.) Once the information is submitted and the application is complete, I will continue to process your application accordingly. If the additional information is not provided to the County within 180 days of this request, the application shall expire and no further action on the proposed development shall take place. Please contact me at (360) 427-9670, ext. 365 if you have questions. Sincer ly, AVA-1, (Allan Borden Land Use Planner Mason County Planning Department 12/19/2011 Page 1 of 3 COM2011-00104 NOTIFICATION OF INCOMPLETE APPLICATION 12/19/2011 Case No.: COM2011-00104 Comments: The retail store proposal at 23030 NE State Route 3 in Belfair was subject to a Pre-Submission Conference PAR2011-00022 held on September 28, 2011. Your submitted building plans on December 1, 2011 did not include a submitted geotechnical report, a special study needed for the development proposal, as noted in the Planning Department review comments for PAR2011-00022; those comments are included. PAR2011-00022 APPLICANT: Buddy Webb O'Reilly Auto Parts MEETING DATE/TIME: WED. Sept. 28, 2011, 9:30 a.m. PARCEL NUMBER: 12332-50-00942 SITE ADDRESS: 23030 NE State Route 3, Belfair WA PROJECT DESCRIPTION: New auto parts retail, parking, landscaping REVIEW COMMENTS BY PLANNER: Allan Borden (360.427-9670 ext. 365) [from Belfair 360.275-4467] Parcel in proposal: 12332-50-00942. Proposed land use: Auto parts retail building and associated parking. Critical Area concerns: Slope / landslide hazard values; applicant shall have qualified engineer or geologist (a consultant list is available on Mason Co. website) provide geotechnical report for 62 + percent slope at south and east portions of the property, that is 70 feet from new building footprint (submittal checklist is on website). Zone: Belfair Urban Growth Area Mixed Use (MU). Building Height limit: maximum of 45 feet (applies on the east side of the State Route 3 right-of-way. Area / Building size: no limit. Setbacks: Title 17.23.250 and depends on adjacent uses and adequate landscaping around buildings and parking. Landscaping: Title 17.23.265 and applicable 17.31 standards Parking needs: 1 stall per 300 sq. ft. net floor area; plan to account for surface runoff per 2005 DOE stormwater standards and in coordination with WA Dept. of Transportation. Access: in coordination with WA Dept. of Transportation. Sewer: Development Regulations require connection to Belfair UGA system as it is implemented in the next two to five years; in coordination with Mason County Utilities & Waste Management. Site plan needed to implement the site preparation grading and development for buildings, parking, sewer and stormwater improvements. 12/19/2011 Page 2 of 3 COM2011-00104 NOTIFICATION OF INCOMPLETE APPLICATION 12/19/2011 Case No.: COM2011-00104 Signs: monument signs at road; and wall or facade signs on buildings per Title 17.34 for Belfair UGA. 12/19/2011 Page 3 of 3 COM2011-00104 Date: 7/3/2011 `7 Letter of Certification Time:4:20 PM Page: 1 of 1 Letter of Certification Contact Mr.Steve Peterie/Mr.Gayle Woods Project:Belfair,WA Name:O'Reilly Automotive,Inc. Builder PO#:BFR Address:233 S.Patterson Ave. Jobsite:23030 NE Route 3 City,State:Springfield, Missouri 65802 City,State:Belfair, Washington 98528 Butler Order No.193733 County,Country: Mason, United States This is to certify that the above referenced project has been designed in accordance with the applicable portions of the Building Code specified below. All loading and building design criteria shown below have been specified by contract and applied in accordance with the building code. Overall Building Description Shape Overall Overall Floor Area Wall Area Roof Area Max.Eave Min.Eave Max.Roof Min.Roof Peak Width Len (sq.ft.) (sq.ft.) (sq.ft.) Height Height 2 Pitch Pitch Height Belfair,WA 100/0/0 70/0/0 7000 5075 7002 1W7112 16/6/12 0.250:12 Storefront Portal 0/8/8 52/0/0 37 1399 37 17/610 17/610 0.000:12 Total For All Shapes 7037 6474 7038 Loads and Codes-Shape:Belfair,WA City: Belfair County: Mason State: Washington Country: United States Building Code:2009 International Building Code Built Up: 05AISC-ASD Rainfall:4.00 inches per hour Building Use:Standard Occupancy Structure Cold Form: 07AISI-ASD 3000.00 psi Concrete Dead and Collateral Loads Live Load Collateral Gravity:2.50 psf Roof Covering+Second.Dead Load:Varies Live Load:20.00 psf Reducible Collateral Uplift: 0.00 psf Frame Weight(assumed for seismic):2.50 psf Wind Load Snow Load Seismic Load Wind Speed:86.00 mph Ground Snow Load:25.00 psf Mapped Spectral Response-Ss:130.60%g The'Low Rise'Method is Used-User Modified Flat Roof Snow:20.00 psf Mapped Spectral Response-S 1:48.30%g Wind Exposure(Factor): B(0.701) Design Snow(Sloped):20.00 psf Seismic Performance/Design Category:D Parts Wind Exposure Factor:0.701 Specified Minimum Roof Snow:22.50 psf Seismic Importance: 1.000 Wind Enclosure:Enclosed Snow Exposure Category(Factor):2 Partially Seismic Performance/Design Category:D Exposed(1.00) Wind Importance Factor:1.000 Snow Importance:1.000 Framing Seismic Period:0.2777 Topographic Factor:1.0000 Thermal Category(Factor):Heated(1.00) Bracing Seismic Period:0.1719 Ground/Roof Conversion:0.70 Framing R-Factor:3.5000 NOT Windbome Debris Region %Snow Used in Seismic:0.00 Bracing R-Factor:3.2500 Base Elevation:0/0/0 Seismic Snow Load: 0.00 psf Soil Profile Type:Stiff soil(D,4) Primary Zone Strip Width:13/3/0 Unobstructed,Slippery Roof Diaphragm Condition:Flexible Parts/Portions Zone Strip Width: 6n18 Frame Redundancy Factor:1.3000 Basic Wind Pressure:11.28 psf Brace Redundancy Factor:1.3000 Frame Seismic Factor(Cs):0.2488 x W Brace Seismic Factor(Cs):0.2679 x W Design Spectral Response-Sd1:0.4885 Design Spectral Response-Sds:0.8707 Building design loads and governing building code is provided by the Builder and is not validated by Butler Manufacturing,a division of BlueScope Buildings North America,Inc.The Builder is responsible for contacting the local Building Official or project Design Professional to obtain all code and loading information for this specific building site. The design of this building is in accordance with Butler Manufacturing,a division of BlueScope Buildings North America,Inc.design practices which have been established based upon pertinent procedures and recommendations of the Standards listed in the Building Code or later editions. This certification DOES NOT apply to the design of the foundation or other on-site structures or components not supplied by Butler Manufacturing,a division of BlueScope Buildings North America,Inc.,nor does it apply to unauthorized modifications to building components. Furthermore,it is understood that certification is based upon the premise that all components will be erected or constructed in strict compliance with pertinent documents for this project. Butler Manufacturing,a division of BlueScope Buildings North America,Inc.DOES NOT provide general review of erection during or after building construction unless specifically agreed to in the contract documents. The undersigned engineer in responsible charge certifies that this building has been designed in accordance with the contract do vents as indicated in this letter. A$y�iyGa �at�a Date:- l Engineers Sealy Engineer in responsible charge 9�PE484so�� TEP S�Ow,1 Fx`' 4 12 File: 193733 Belfair,WA 11-21799 Version: 2.3a Butler Manufacturing,a division of BlueScope Buildings North America,Inc. �-� Date: 7/9/2012 csUTL ER Underwriters Laboratory UL-90 Letter Time:3:08 PM Page: l of I Underwriters Laboratory UL-90 Letter Contact: Mr.Steve Peterie/Mr.Gayle Woods Project:Belfair,WA Name: O'Reilly Automotive,Inc. Builder PO#: BFR Address: 233 S.Patterson Ave Jobsite: 23030 NE Route 3 City,State: Springfield, Missouri 65802 City,State: Belfair,WA Zip: 98528 Butler Compass Order Number: 193733 County,Country: Mason County,United States The goods listed herein are purchased subject to the BlueScope Buildings terms and conditions of sale and the limitations contained therein. Roof Covering Building Shape Location Type Thickness Spacing Belfair,WA(BFR)-100'x 70'Retail Store Roof:A MR-24 24 Standard Option MR-24 Roof UL-90 Certification This is to certify that the Butler Manufacturing MR-24 ROOF SYSTEM,when installed in accordance with Butler Manufacturing Standard Erection Details(SEDs)and Erection drawings,will meet Underwriters Laboratories UL Class 90 Uplift Rating. The MR-24 roof system has been tested in accordance with UL test procedure 580 and is listed under Construction No's.62 or 62A. By: Date: Paul Hoskins Project Clarifier/Eng.Technician Specialty Engineering Butler Manufacturing A Division of BlueScope Buildings,N.A. 1540 Genessee St. Kansas City,MO 64102 (816)968-3369 Version:2.2 Butler Manufacturing,a division of BlueScope Buildings North America,Inc. Re�II AUTO PARTS. Y9771=1117 in;173=7" P.O. Box 1156 * 233 S. Patterson Springfield, MO 65801 Phone (417)-862-3333 www.orei"llyauto.com June 23, 2011 RECEIVED � City of Belfair JuNzl �J Mason County Dept of community Development MASON CO. PLA,^,N'NG DEPL Planner Attn: Allan Borden PO Box 278 Shelton, WA 98584 RE: New O'Reilly Auto Parts Store (BFR) 23030 NE State Route 3 Belfair, WA 98528 Dear Mr. Borden, In a cooperative effort to communicate with the City in the initial stages of the planning process we are attaching a PRELIMINARY SITE DEVELOPMENT PLAN for the above referenced project for review and comment by the City. We would appreciate a response as soon as possible so that we may proceed with a mutually agreeable design solution into the final construction document phase. We hope that with this submittal, any major delays during the Cit 's final Ian review will be greatly diminished. Y p 9 Y Please contact our office if additional information or clarifications are required. O'Reilly Auto Parts looks forward to becoming a contributing part of the Belfair community. Respectfully, O'Reilly Automotive, Inc. 10000, &,�r / ' /&er `'G Billy Moore Project Designer 417-862-2674 ext: 1855 417-874-7229 fax bmoore8@oreillyauto.com Attachment cc: File-Design RIGHT PART, RIGHT PRICE GUARANTEE! Page 1 of 1 Allan Borden - O'Reilly Automotive Store in Belfair WA; additional information From: Allan Borden To: Paul Engel Date: 12/20/2011 2:42 PM Subject: O'Reilly Automotive Store in Belfair WA; additional information CC: Allan Borden Attachments: geotech_report_checklist.pdf; geo_study_preparer_list.pdf; O'Reilly Automotive incompleteness letter.pdf Paul Engel: I am reviewing the submitted plan materials for a new commercial store in Belfair WA. and I have noted that the geotechnical report to support the proposed construction was not included in the application materials submitted to the Mason County Permit Assistance Center. This special study was pointed out at the Pre-Submission Conference of Sept. 28, 2011, when you met Mason County staff to go over the needed information and permit review process. I have attached to this message the Letter of Incompleteness that is associated with the building permit COM2011-00104. I have also included the list of geo study preparers familiar with the county standards and the submittal coversheet for the needed study. You may contact me for added info or your questions. Allan Borden Planner - Long Range &Site Inspection P.O. Box 279, Shelton, WA 98584 (360) 427-9670 ext. 365 file://C:\Documents and Settings\Ahb\Local Settings\Temp\XPgrpwise\4EF09EE8Masonmai110... 12/20/2011 Page 1 of 2 Allan Borden - RE: O'Reilly Automotive Store in Belfair WA; additional information From: "Paul Engel, PE" <pengel@aeincmo.com> To: "'Allan Borden"' <Ahb@co.mason.wa.us> Date: 12/20/2011 2:53 PM Subject: RE: O'Reilly Automotive Store in Belfair WA; additional information CC: "'Wade Lininger"' <wade@webbarch.com>, "'Aaron Hargrave, PE"' <aargrave@aeincmo.com> Allan, Thanks for the info. I will check with our Architect, Wade(Project Manager), to get you the geotech report referenced. Paul J. Engel, PE Vice-President/Project Manager A N D E R S 0 N �--ENGINEERING,tNc E M P L O Y E E O W N E D A CMS ENGWEERMt o t LAND SYMMMG COMPANY 2045 W Woodland, Springfield MO 65807 417-866-2741 Office 417-840-2517 Cell PVJd""'° A think befotr ytm print Fac�t+oak Anderson Engineering, Inc. does not assume any liabilities for unauthorized alterations to the information contained herein, and grants a temporary license to the recipient of this email for the use of material contained in any attached files for development of recipient's work. Anderson Engineering, Inc. does not warrant the accuracy of any information contained in these emailed files, but Anderson Engineering, Inc. retains all rights to the use of the emailed material.The information contained in this email, including any attachments, is privileged, confidential and intended for the sole use of the individual or entity to whom it is addressed. It is the responsibility of the addressee to scan for any computer viruses or other defects. The sender does not accept liability for any loss or damage of any nature which may result from this email or any attached file. If you are not the intended recipient,you are notified that any use, distribution or copying of the message is strictly prohibited and may subject you to criminal or civil penalties. If you have received this email in error, please notify the sender immediately by reply email then delete any printed or electronic copies. From: Allan Borden [mailto:Ahb@co.mason.wa.us] Sent: Tuesday, December 20, 2011 4:43 PM To: Paul Engel Cc: Allan Borden Subject: O'Reilly Automotive Store in Belfair WA; additional information Paul Engel: I am reviewing the submitted plan materials for a new commercial store in Belfair WA. and I have noted that the file://C:\Documents and Settings\Ahb\Local Settings\Temp\XPgrpwise\4EFOA173Masonmai11001... 1/5/2012 Page 2 of 2 geotechnical report to support the proposed construction was not included in the application materials submitted to the Mason County Permit Assistance Center. This special study was pointed out at the Pre-Submission Conference of Sept. 28, 2011, when you met Mason County staff to go over the needed information and permit review process. I have attached to this message the Letter of Incompleteness that is associated with the building permit COM2011-00104. I have also included the list of geo study preparers familiar with the county standards and the submittal coversheet for the needed study. You may contact me for added info or your questions. Allan Borden Planner - Long Range&Site Inspection P.O. Box 279, Shelton, WA 98584 (360) 427-9670 ext. 365 file://C:\Documents and Settings\Ahb\Local Settings\Temp\XPgrpwise\4EFOA173Masonmaill001... 1/5/2012 MASON COUNTY PERMIT Nq�� I �`�✓� BUILDING PERMIT APPLICATION 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 Shelton (360) 427-9670• Belfair (360) 275-4467• Elma (360) 482-5269 On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner tV)26-I LL`( 4Ll O e�)-1V& ST iS , _� Company Name Mailing Address Mailing Address cityc,paq4A itiKipqQ. v Zip Code 5 2 City State Zip Code Phone l-2C. Other Ph. Phone Other Ph. Lien/Title Holder Contractor Reg.# Exp. E mail address .� 1 E Mail Address Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System GJfi�' 9�% # �t�. j IZ DIS)YLIGT 401 Well Water System Name of Water System PARCEL INFORMATION- 12 Digit Parcel No - o D Fire District Legal Description Site Address(Please include street name, street number and city) 13-0725tv Directions to site 2 FC';:r�a �Su►tiV 6, Will timber be cut and sold in parcel pre aration?Yes Is property ithin 200'of Saltwater LakeV—River/Creek 9_Pond Wo Wetland aLb Seasonal Runoff Stream Slopes or Bluffs > 15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB- New X Add Alt Repair Other PRIMARY RESIDENCE ❑ SEASONAL ❑ Use of Building t�. 4a CE; Describe Work No. of Bedrooms No. of Bathrooms 'I Square Footage- 1 st Floor -7I 000 2nd 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 Name Certification No. OWNER/BUILDER Acknowledges 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,owners legal representative,or the contractor.I further declare that I am entitled to receive this permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary parties.If permission is required from any easement holder or any other party in interest regarding this application or the work proposed in the application,I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection. PR OF O UATION WORK IS BY MEANS OF A PROGRESS INSPECTIO . X — — '5 W GO Date Owner 47wnerga resentatrve/Co tractor indicate which one FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department Public Works Department cps Fire Marshal �— FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing& Base Fee Planning Review Fee Mechanical& Base fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation$ TOTAL FEES MASON COUNTY PERMIT NO. PLUMBING/MECHANICAL PERMIT APPLICATION 426 W. Cedar• P.O. Box 186, Shelton,WA 98584 Shelton(360)427-9670•Belfair(360)275-4467•Elma(360)482-5269 On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner 0��?illil. FZ2 / Company Name Mailing Address Mailing Address City State Zip Code o City State Zip Code Phone 2' (a Other Ph. Phone Other Ph. Lien/Title Holder Contractor Reg. # Exp. E mail address �'j� • E Mail Address Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC INFORMATION - Connec to New Septic Existing/Septic- Connect to Sewer System Name of Sewer System L. wa PARCEL INFORMATION- 12 Digit Parcel No Fire District Legal Description S Site Address(Ple se include street name,street number and city) Directions to sitM--� Z Is propert ithin 200' of Saltwater ULO Lake River/Creek C3 Pond Wetland JD Seasonal Runoff Stream Slopes or Bluffs > 15% TYPE OF JOB- New Add Alt Repair Other Use of Building Location of Fixtures/Units- 1 st Floor__� 2nd Floor Basement Garage Closet PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Type of Fixture No. of Fixtures Fees Fuel Type:Electric_LPG_Natural Gas,-Heat Pump_ Toilets 2 Type of Unit No.of Units Fees Bathroom Sink Furnace Bath Tubs Heatpumps D Showers Spot Vent Fan Water Heater I Propane Tank D Clothes Washer Gas Outlets Kithen Sinks LrL Wood/Gas/Pellet Stove D Dishwasher D Kitchen Exhaust Hood O Hosebibs Dryer Vent D Other Other 0 Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL OWNER/BUILDER Acknowledges 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,owners legal representative,or the contractor.I further declare that I am entitled to receive this permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary parties.If permission is required from any easement holder or any other party in interest regarding this application or the work proposed in the application,I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection. PR F CO INUATION OF ORK IS BY MEANS OF A PROGRESS INSPECTION. Datel 1 $11 I Owner/ wners Representative Contract (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Planning Pd Ck# Date Bld Pd Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Occ Group-Type Constr. Planning Department Environmental Health Department FEES Plumbing & Base Fee Site Inspection Mechanical & Base fee UFC Plan Review Fee Wood/Gas/Pellet'Stove Fee Other Violation Fee TOTAL FEES