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Q �' m o CD p Cr 3 00 noao CL C: ° Q m 0 0 � 0 a f- 0 m 3 .. - _ < o I0_ � x o c CD Q v) DO cnamo F. ° _ CD o � Qcr Cn 0 --q 9: CONCRETE MECHANICAL MANUFACTURED HOME C m - C� Date By Footings/Setbacks Gas Piping Ribbons m C) Interior Date By Interior-Date By Date By X C� C 00 Exterior Date By Exterior-Data Bv Set-up Cf) INSULA71ON 0 Point Load I Isolated Footings BG I SLAB INSULATION Date By m z Date By Data By FIRE DEPARTMENT Foundation Walls Floors Date By Date By Data By DECKS X FRAM ING Walls Date By By Date By Data PROPANE TANKS PLUMBING Vault Date 13Y Date BY OTHER Groundwork Attic Type- Date By Date By Data By DRYWALL Type: 13Y 0 0 mvv.v Int Brace Wall Date Date By te 9 D By FINAL INSPECTION Water Line Fire Seperation, Date By Date By Date 2-/-1*- BYO _rr Pass or Request Inspect. -Type !#Insp. Fail --Date Date Done By Comments co -e e- 7 ),t7. f > A-r.Pwv>_ i2r - -7 opt, #6% ;L) r-Af m P.(- Sete A 4-+, tA AL t I I 0 (0 f BUILDING MASON COUNTY 360)427-9670 Shelton ext.352 6oN cGU� DEPARTMENT OF COMMUNITY SERVI `CEjVEtj 275-4467 Belfairext. 352 BUILDING•PLANNING.FIRE MARSHAL (360)482-5269 Elma ext. 352 Mason County Bldg. 8 NOV2 2017 615 W.Alder Street, Shelton,WA 98584 615 W. Alder Stred(ww.co.mason.wa.us COM7011 -( ll CHANGE IN TENANT APPLICATION PROPERTY INFORMATION Date: 2" Assessor's Parcel Number: 12.331.—50-ot)o 2. Legal Description:SM P,.'R (�'s" CME,4i 'Tf,� "T� or' -Tp 1 N4 i Building Site Address: '2-32y b Wzr WA q $ APPLICANT INFORMATION Name of Applicant: ,+_ df S wh5hw Mailing address: 22`" City: ) �, State: Zip: 'IY5 2_g Day phone: Contact Person: ;r4,,crl S�l c{ r Message phone:C? v'sssU i PROJECT INFORMATION Proposed business name: S-tLL ei,U. —Lpjj h sf " Proposed use: pen { QW�c�. Number of employees: Previous business name: FWAr AN(v\&i HC g i N Describe previous use: VC1+ STRUCTURE DETAILS Check one: X Detached single level/single tenant O Single level/multi tenant O Multi level/single tenant O Multi level/multi tenant Arof structure: Is structure currently If not occupied, how long has it been vacant? l occupied? Yes o> Yr. Mo. Square �52 Basement: First: Mezzanine: Second: Third: footage: as- Is the structure Type of Heat: Circle one: Furnace Heat Pump Electric wall Radiant heated? Circle one: Ees No Fuel e: Circle one: Electric Liquid Propane Natural Gas Oil mere be any changes to the following? cie yes or no, if applicable: Floor lay-out: Ye No Lighting: Yes l�� Heating: Yes �eNc Exterior Finishes: Yes o Interior Finishes: Yes (&�' Parking: Yes Number of restrooms provided: Number of fixtures in each: Water Closets I LavqWies Bath/Shower Is structure handicap accessible? Entry Y s No Restroom(s): Ye No j 1 f I I , Is the structure equipped with a fire sprinkler system? Yes No Fire alarm system? Yes No 0, Monitoring Station Name: Phone number: CC/1,1 r +� 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) Continued on back t 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 permitiapplication 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 CONTINUATION OF WORK IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. x �� �� � /Mu Signature/of Applicant Date' X (� S ��lj� Owner/ wners Re Les /Contractor Print Name (circle to indicate which one) Official Use Only Accepted by Date I-Z—( _Submittal Amount$�s3 l LP..70 Receipt number Department view Initials Date Comments BuildingLl� 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 PLANNING: PLANNING RECEIVED _ ALL SETBACKS ARE MEASURED \ NOV2 ZO17 FROM THE FURTHEST PROJECTION OF THE B bIN 16 . Alder Street I APPFOVED-tAA ON COUNTY DCD PLANNING SI PLAN REQU RED O BEON SITE V` t C NGES SUB.ECT paC1 �� Date AACrIp ago CA isstnrlC %.talk W71- 7A7 Hi6 k1A y � m Wd Ot5 APPROXMAI'R-SITE 1"KETCI Q N= Hyd�un�- .Focmer Doctors Clinic f 3elfair 1AIJbf l t�. s PROPOSED CHANGES: 1. Remove partition wall that was added to original waiting room to divide it from Veterinary Clinic's X-Ray room. 2. Replace plywood on exterior wall of waiting room and put windows in that match the ones that were previously removed when the Veterinary Clinic created their X-Ray room. (2 small upper windows and 2 lower windows) 3. Wall off entrance to alcove in waiting room and change entry point to main hallway. This also requires the removal of a portion of the wall in the alcove that is on the hallway side. 4. Former doctor's office and manager's office- Add sink to existing counter/cabinet areas and make a 2ft. opening on the hallway wall to create 2 points of entry to each room. 5. Bathrooms remain the same unless sinks or toilets need to be replaced for functionality. 6. 4 exam rooms on rear side of building need 2 ft. openings on hallway side wall to create 2 points of entry to each room. 7. 02 system will be updated to place piping in wall instead of on the exterior of wall. 02 will be added to exam rooms#1-7 and removed from former X-Ray room. Nitrous will be plumbed into each exam and surgical room. 8. Wall will be extended from Reception area to exterior wall on south side of building so that waiting room is separated from new X-Ray area. 9. Former X-Ray developing room becomes alcove for Panoramic X-Ray machine and entry is made from hallway that runs to rear of the building. 10. Sterilization room will be enclosed with a wall adjacent to the hallway that will now contain a 3ft. door. 11. Exam room#7 current doorway will be enclosed 12. Wall between Exam rooms#7 and#8 will be removed to create a 3ft. door and 2 ft. opening into Exam room#7 and a 3ft. 4in.X 7ft. 6 in. hallway will be created between Exam rooms#7 and#8. The new hallway will also allow for a 3ft. door and 2 ft. opening for Exam room#8. 13. 12 ft. X 1 Oft. 3in(approximately 120 sq. ft.) addition to the rear of building will create space for a small doctor's office (with a 4ft.X3 ft. window) and extend the current hallway back so that the rear exit door will now be flush with the rear of the building. 14. Entrance to lab from surgical operatory will be walled off and you will now enter the lab from a 3ft. door on the left side of the extended hallway. 3A 15. Former Kennel room now becomes employee break room and will have a V X 3ft. window added to rear wall. The sink in this room will be replaced. 16. Isolation area of former Kennel room will now become employee bathroom with a wall mount toilet and small sink. 17. STUDERUS DENTAL sign on top of existing sign's concrete base. STUDERUS DENTISTRY ADDRESS: NE 23240 Highway #3 Belfair, WA 98528 TAX PARCEL NO: 12332-50-00021 LEGAL DESCRIPTION: That portion of Tracts 9 and 11 of Sam Theler's Home and Garden Tracts, Volume 4 of Plats, page 20, described as follows: Beginning at the intersection of the South line of the North 10 feet of Lot 11 with the Easterly line of State Highway; thence Northeasterly along said Highway 160 feet; thence East parallel to the South line of the North 10 feet of said lot 11; 500 feet; thence South parallel to the East line of said lot 11 to the South line of the North 10 feet of said lot 11 to the true point of beginning, according to the records of Mason County, WA. 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