HomeMy WebLinkAboutCOM2020-00009 Equipment Addition - COM Application - 1/28/2021 MASON COUNTY COMMUNITY SERVICES Permit No:U�1►/�0,�("OQ'Y{�
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 Phone120 JILDING
BeBair.(360)275-4467•Phone Elma:(360)482-5269 BUILDING PERMIT APPLICATION JAN 2 8 ml
PROPERTY OWNER INFORMATION: �-} -�
CONTRACCTORI�NFORMX'fi011i: [Alu-'eC Street
NAME: t4-eq �-I,e✓' `�1 n r�7 1 - - NAME: -"l 9S tie L Kye k J E,I k VCN,j.� C
MAILING ADDRESS: r 1 e r)n 41 ► '•S z- MAILING ADD SS:444" ti� g
CITY: ru Al W4+-lY STATE:W ZIP' -y CTTY: K C h f S-TATE: ZIP: C. Z
PHONE#1: PHONE:0b b ,T 1 CELL:
PHONE#2: EMAIL:
EMAIL: L&I REG# U EXP. /
PRIMARY ON T: OWNER❑ CONTRACTOR +OTHE
NAME I It1 EMA[ `1YI L' S ,
1 t'�Lti
MAILING ADDRESS KPI 0 CITY r STATE ZIP
PHONE CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 122-17 Z Z0003 Z_ ZONING
LEGAL DESCRIPTI9 j(�bbreviated).H 1Z..+ I Xl rw FIRE DISTRICT tt
SITE ADDRESS / '`�3S T Izo 4 te,3 ITY ;41 1 y�l
DIRECTIONS TO SITE ADDRESS ' io
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NOX 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: NEWK' ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
j yt wl cl I USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.) w j r e I�� �l Y►1 t C A fi tl'y It
IS USE: PRIMARY SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCT ? YES(Whole Bldg)0 YES(Part4sj ofBtdg)`� NO
DESCRIBE WORK �kS ! 'Wa f9- HSS C u I ON
SQUARE FOOTAGE:(proposed)
1ST FLOOR2Z 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 N
Ifyes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ A NO❑ EXISTING SQ.FT.
4 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
r COUNTY CODE 14.08.42)
X W4,
Signature of OWNER(Must siune by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH
SETBACK TABLE: NOTE: PREPARED FOR
TOWER BASE TO PARENT PROPERTY LEASE BOUNDARY TO PARENT 1. (PI AT&T POWER/FIBER ROUTE
LINE PROPERTY UNE
AND P.O.C.TBD BY UCR.
NORTH -4811V -457-7
SOUTH -29'-0' -46'4T
EAST -474'-0' -496'-0- AT&T
WEST -61'i7' -19'-0"
R E C VL NEW CINGULAR WIRELESS PCS,
19801SW72NDAVE.,STE.200
J A N LI - TUALATIN,OR 97062
A L Q�,� Vendor:
615 W. Alder Street
rIjj5INFRASTRUCTURE
I
2030 MAIN STREET,SUITE 200
IRVINE,CA 92614
APPROVED PARCEL ID: 122172200031 ZONED: RR10 RURAL RESIDENTIAL PLANNING
JS PROJECTIO:P-048132
MASON COUNTY DCD PLANNING Issued For:
SITE PLAN REQUIRED TO BE ON SITE I I TA3377
CH NGES UBJECTTO APPROVAL
Date �t O�2 I _� ALLYN DEVEREAUX LAKE
By (E)PRIVATE DRIVEWAY -
(E)EDGE OF ` '; ? ;� I ( ;�., • 19943 EAST STATE ROUTE 3
ASPHALT ACCESS , 1,iN 1 JI . , ALLYN,WA 98524
i T. ^ �' ?E MEASURED PARCEL ID:122172200032
�L SE H ,GKS Al
rROM THE FURTHEST
/ F PO►EC-MON OF 1 HE BUILDING I DRAWN
(E)GATE � I CHECKEDD BY::
I ��4 A 12/31/201 90.CD
iQ. I 0 1/25/21 100%CD
(E)GRAVEL �PO
ACCESS
OF,A
F �
PARCEL ID: 122172360000
ZONED: RR10 RURAL RESIDENTIAL
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1;A I PARCEL ID: 122172200032 w
;Cl ZONED: RR10 RURAL RESIDENTIAL
REV DATE D RIPTI N
474'-9'
Licensor.
(E)48'-0"X 48'-0"COMMUNICATIONS
COMPOUND(2,293 SQ.FT),LOCATION OF
(P)AT&T 19'-0'X 12'-0"(228 SQ.FT.)LEASE AREA
I � h
Y -
PROPOSED AT&T
PROJECT AREA (E)PROPERTYLINE
REFER TO ENLARGED SITE PLAN & 1 ZZ�Z�
COMPOUND PLAN ON SHEET A-2 61-0" (E)150'-0 TALL MONOPOLE sEcro
BY OTHERS
�°AZIA.tUTH
Sheet Title:
aPARCEL ID: 122172100040 SITE PLAN
ZONED: RR10 RURAL RESIDENTIAL
Sheet Number:
A-1
SITE PLAN 24"v36-SCALE: 1" = 50' 5O 2 50' 0R 1