HomeMy WebLinkAboutCOM2019-00014 - COM CD Environmental Health Review - 1/24/2019 EC�-S�is
MASON COUNTY '` r (360)427-9 I ext.352
DEPARTMENT OF COMMUNITY SERVICES (361j)"5,�44F fair ext. 352
BUILDING•PLANNING•FIRE MARSHAL (360)482-526 a ext. 352
615 W. Alder Street
Mason County Bldg. 8
615 W.Alder Street, Shelton,WA 98584
o-OCR www.co.mason.wa.us .
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CHANGE IN TENANT APPLICATION
Date: Assessor's Parcel Number: ( a - 9'-1 30 a?O
Legal Description: Vc ; r A X5T it Icu-iN --�
Building Site Address: a 3 -) �O n� S i� 3 e i a+t i.3 �a 2 f
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_ _A .w ;`APPI;ICAT INFORMATION:
Name of Applicant: ,b ;"r !o c►a✓
Mailing address:
City: 30 VA.)I 1 Val � State: � ,Fj- zip 9 &,3 7)
Day phone: Contact Person: �,� Message phone: ,*aG �?r9 '13 6
PROJECT INFORMATION '
Proposed business name: iJ U 0 C 5 y% 2 0 I P,r -r t 11
Proposed use: i3 . ,r Number of employees: I 1-1
Previous business name , v ;o Ae_o " Describe previous use:
STRUCTURE DETAILS
Check one: 3*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? a No Yr. Mo.
Square Basement: First: Mezzanine: Second: Third:
footage: 1,a 5 o n 6 \/ ,& 5 42 '2
Is the structure Type of Heat: Circle one: =d_ffiace Heat Pump Electric wall Radiant
heated? -"�
Circle one: o No Fuel type: Circle one: Electric Li uid Propane atural Gas Oil
Will there b any changes to the following? Circle yes or no, if app ica e:
Floor lay-out: Yes Lighting: Yes550)
Heating: Yes
Exterior Finishes: Yes Interior Finishes: Yes Parkin : Yes
Number of restrooms provi ed: Number of fixtures in each:
Water Closets 0 Lavato_ies a Bath/Shower 0
Is structure handicap accessible? Entry: No Restroom(s): �e No -
Is the structure equipped with a fire sprinkler system? Yes Fire alarm system? Yes moo)
Monitoring Station Name: Phone number:
APPLICATION WILL NOT BE ACCEPTED WITHOUT:'
Floor Plan (5 sets):
• Draw the floor plan to scale • Use of rooms
• Room Dimensions • Location of all exits and windows (include dimensions,
• Location of plumbing and mechanical fixtures counters, tables, shelving, benches, fire exits
• Interior doors with swing radius and exit signs).
Site Plan (1): Note scale used
• Property lines, easements, & right of ways • Location of all existing structures &dimensions
• Distance, in feet,from property line & structures • Location of all existing structures &dimensions
• On-site sewage tanks and drain fields, & reserve • Landscape buffer yards
• Location of fire hydrants&vehicle access roads • Well location
• Parking areas number&arrangement) O f r
Continued on back n ear'
t V
If construction or remodeling is proposed an additional Building Permit and construction
documents/drawings may be required.
After permit issuance and compliance to all conditions is complete,
schedule an inspection by calling
360.427.9670 ext. 352
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 contractor. 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 authorized agent 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 CONTII IIMATION OF WORK IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PERMIT
APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
f, —
Signature of Applicant Date
X PC t0{,P- Pro L� Owner/Owners Representative/Contractor
Print Name (circle to indicate which one)
Official Use on
Accepted by Date Submittal Amount$ Receipt number
Department Review Initials Date Comments
Buildin
Fire Marshal
Planning
Occupancy Change? (circle one) Yes No Land Use Designation:
Occupancy classification change from to New occupant load calculated: persons
Existing occupant load design persons. Type of construction
FLOOR PLAN
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30.5' gy
1/2 Bath 1/2 Bath J
Guys Gals Office
NY
�4
o Kitchen
2 _
_ IVA
V
�- 9.5'
LO
--
pen
(walk-in)
Cold Storage
U
imp
(o
service area N
N Cr cn
bark unter
tables/chairs �. tables/chairs
16' 16'