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HomeMy WebLinkAboutCOM2022-00092 wireless comm facility - COM Permit / Conditions - 9/22/2022 g" MASON COUNTY COMMUNITY SERVICES Permit No.& t 0009� PERMIT ASSISTANCE CENTER: •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL 615 W.Alder Street,Shelton,WA 98584 " Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone Belfair(360)275-4467•Phone Elma:(360)482-5269 BUILDING PERMIT APPLICATION PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: NAME:WA State Patrol Academy NAME:TBD MAILING ADDRESS:631 W.Dayton Airport Rd MAILING ADDRESS: CITY:Shelton STATE:WA ZIP:98584 CITY: STATE: ZIP: PHONE#1:N/A PHONE: CELL: PHONE#2:NIA EMAIL: EMAIL:NIA L&I REG# EXP. PRIMARY CONTACT: OWNER❑ CONTRACTOR❑ OTHER 0 NAME Bryson Burghardt-Smardink c/o T-Mobile EMAIL byson.burghardt@smartlinkgroup.com MAILING ADDRESS 11232 120th Ave NE,Suite 204 CITY Kirkland STATE WA ZIP 98033 PHONE 360-581-8189 CELL N/A PARCEL INFORMATION: PARCEL NUMBER(12 Digit Number) 42002-32-60010 ZONING URBAN GROWTH AREA LEGAL DESCRIPTION(Abbreviated) TR 1 OF N1/2 SW FIRE DISTRICT 11 or 16 SITE ADDRESS 631 W.DAYTON AIRPORT RD CITY Shelton DIRECTIONS TO SITE ADDRESS From 101 N,turn left on W Dayton Airport Rd,then turn left at 631 W Dayton Airport Rd IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NO I] SNOW LOAD:_psf IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply): SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑ TYPE OF WORK: NEW❑ ADDITION❑ ALTERATION❑+ REPAIR❑ OTHER ❑✓ Wireless Comm Facility USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.)Wireless Communication Facility IS USE: PRIMARY❑ SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS HEATED STRUCTURE? YES(Whole Bldg)❑ YES(Part[s)ofilldg)❑ NO❑ DESCRIBE WORK Replacement/upgrade of antennas and mounts on tower.Replacement of ground equipment on existing pad.No increase or expansion. SQUARE FOOTAGE: (proposed) I ST FLOOR sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft. DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft. GARAGE sq.ft. Attached❑ Detached❑ CARPORT sq.ft. Attached❑ Detached❑ MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED* MAKE MODEL YEAR LENGTH WIDTH BEDROOMS BATHS SERIAL NUMBER ENVIRONMENTAL HEALTH: SEWAGE/SEWER SOURCE: SEPTIC❑ SEWER❑ / NEW❑ EXISTING❑ PLUMBING IN STRUCTURE? YES❑ NO❑ Ifyes,attach completed Water Adequacy Form PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NO[] EXISTING SQ.FT. EXISTING BEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS OWNER acknowledges that 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 and 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 legal representative,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 permittapplication 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 ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON COUNTY CODE 14.08.42) X 9/22/2022 S7griature of OWNER(Must be signed by the OWNER) Date DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT FIRE MARSHAL PUBLIC HEALTH . qp a§ �/ � ` � \ ! '®| § § § \|�\O\ � !||§ Rugg§!�| § 2� \/ /\ --—--� - —-- . --- | , � �--- � | , \ Li . | �--- / / - ! 90 » | . . . |� �- \ / � . \ . |� --—--—--—-- � � y : \| §| | \ \ \ 0 \� §l \ --- 0 $ 2/ ).. \ � $ �) � g( g .| \/ f» ■ --—-- Nn d , F», � &DE RSO & W y �----] z ■ «7\ Iq%© a)\J| ) _ 2G � /p; ||■ ] ■ t--I; OD) /\ / / : : y k� � � , 2 c -, , R 1 oil § q� \� ! ;