HomeMy WebLinkAboutCOM2014-00105 Cell Tower Additions - COM Permit / Conditions - 9/9/2014 MASON GOUN I Y Uth I . OF GOMMUNI I Y UtVtLUNMENT 111Jf1CL:LIV11 LIIIC 1JVV)9L/ /LVL
Mason County Bldg. III Phone: (360)427-9670, ext. 352
426 W. Cedar
Shelton, WA 98584
IR.W
COMMERCIAL BUILDING PERMIT COM2014-00105
OWNER: SPRINT SPECTRUM RECEIVED: 7/29/2014
CONTRACTOR: LICENSE: EXP: ISSUED: 9/9/2014
SITE ADDRESS: 19941 E STATE ROUTE 3 ALLYN EXPIRES: 3/9/2015
PARCEL NUMBER: 122172200032
LEGAL DESCRIPTION: N 1/2 NW 1/4 EX ST R/W TR B SURVEY 9/137
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
ADD (3)ANTENNA, (3) RRH, (6) UNCTION CYLINDERS
ONTO AN EXISTING TOWER NO HEIGHT INCREASE NO
GROUND WORK
General Information Construction&Occupancy Information
Type of Use: COMMUNICATION Insp. Area: No. of Units: Type of Constr.:
Type of Work: ALT Fire Dist.: 5
No. of Bathrooms: Occ. Group:
Valuation: $ 10,000.00 No. of Stories: Exit Design. Load:
Building Height:
Pre-Manufactured Unit Information Square Footage Information
Make: Length: Lot Size:
Model: Width: Building:
Year: Serial No.: Basement: Parking Spaces:
Setback Information
Shoreline&Planning Information
Front: Ft. Shoreline: Ft.
Rear: Ft. Slope: Ft. Water Body: Shoreline Desig.:
Side 1: Ft. SEPA?: Comp. Plan Desig.:
Side 2: Ft.
Fire Protection System Information
Auto Fire Alarm System?: Emergency Key Box?: Standpipe?:
Auto Fire Sprinkler System?: Access Road?: Fire Extinguishers?:
Fixed Fire Suppression System?: Fire Hydrants?:y Fire Lanes?:
COM2014-00105 Please refer to the following pages for conditions of this permit. Page 1 of 5
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Planning Review Fee TIN 7Mp/2niA 4A3n no R9901A0n
Plan Check Fee TIN 71�pnnlA kIWA 31 R99MAnn
Building Permit Fee -nN 7/9917nid R9R1 7F fi"nlAnn
Building Permit Fee TnA! 719Rr9014 R2Fi1 9fi s1901dnn
Building Permit Fee nN 719a19n14 59B1 9F Si901dno
ADJUST--Plan Check Fe, Tln( R/190n14 .-.19AA An s19n14nn
Building Permit Fee moon R19A19nid to in q12nidnn
Total $1,201.66
CASE NOTES FOR
COM2014-00106
CONDITIONS FOR
COM2014-00105
1) Contractor registration laws are governed under RCW 18.27 and enforced by the WA State Dept of Labor and Industries, Contractor Compliance
Division, There are potential risks and monetary liabilities to the homeowner for using an unregistered contractor. Further information can be
obtained at 1-800-64. - 982. The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to
WA state law. X
2) Owner/Agent is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title
14.28.
X
3) All approved plans are required to be on-slte for inspection purposes. If Inspection Is called for and plans are not on site, Approval WILL NOT be
granted. In addition, a reinspection fee, based on the current fee schedule, minimum one-hour e-r_%arged and collected by the Mason County
Building Department prior to any further inspections being performed or approvals granted. X
4) Approved per gimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
X_
5) Mason County Tel c�`ommunication Tower Ordinance
The proposal alb be in full compliance with the Mason County Cell Tower Ordinance#5-98 (Revised by Ord. No. 53-04).
X
The design of the equipment buildings and related structures shall, to the extent possible, usg�ta ( Is,-colors, textures, screening and
landscaping that will blend the tower facilities to the natural setting and built environment. X r + I'd
Construction Debris Removal
All construction and demolition debris must be removed from the shore area after project completion. Propertdq osal of construction debris must
be on land In such a manner that debris cannot enter or cause water quality degradation of State waters. X Y
COM2014-00105 Page 2 of 5
6) REFERENCING THE 2012 INTERNATIONAL BUILDING CODE, 1704.5:
1
Structural Observation for structures located in Seismic Design Category D areas and work on the structure is over 75-feet above grade shall be
required. MAYES TESTING, INC, the testing agency specified on sheet no. N-1, is approved to perform the structural observation in accordance
with 1704.5
Reports shall be submitted to the Mason County Building Department,426 West Cedar St, Shelton, WA 98584, following each structural
observation. A final observation report shall be submitted prior to the final inspection of the structure. Written statements shall indicate the permit
number,type of inspection, and identify any reported deficiencies.
X
7) Any chang s in construction shall be reviewed by engineer of record and submitted in writing to the Mason County Building Department prior to
construction. All engineering documents are a part of the approved set of plans and must remain attached thereto. If engineering documents are
remov a1p,pro'val will not be granted. In addition, a reinspectlon fee, based on the current fee schedule, minimum one-hour will be charged and
X Ile the Mason County Building Department prior to any further inspections being performed or approvals granted.
8) ALL CONSTRUCTION MUST MEET OR EXCEED ALL LOCAL CODES AND THE INTERNATIONAL CODE REQUIREMENTS AND OCCUPANCY
IS LIMITED TO THE PERMITTED AND APPROVED CLASSIFICATION. ANY CHANGE OF USE OR OCCUPANCY WOULD RESULT IN PERMIT
REVOCATION, CHANGE OF USE MUST BE APPROVED PRIOR TO CHANGE. x
9) The demolition and disposal of debris must meet the regulations of Mason County and Olympic Region Clean Air Agency(ORCAA).
It is unlawful for any person to cause or allow the demolition (or major renovation)of any structure unless all asbestos containing materials have
been identified and removed from the area to be demolished. Work shall not commence on an asbestos project or demolition project unless the
owner or operator has obtained written approval from ORCCA.2490 B Limited Lane NW, Olympia WA 98502, 360.586,1044/800.422.5623
www.orc r
X
10) Changes to approved building plans that affect compliance to the current Washington State Energy Code(WSEC),ventilationrequirements),
Bulldin / biqg/Mechanical Codes and/or Mason County Regulations shall be approved prior to construction.
X i
11) CONSTRUCTION PROCESS TO BE FIELD CORRECTEDAS REQUIRED PER MASON COUNTY BUILDING DEPARTMENT AND THE
ADOPTED BUILDING CODE,
The construction of the permitted project is subject to inspections by the Mason County Building Department. All construction must be in
conformance with the international codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a
Mason o.Unty Building Inspector shall be made prior to requesting additional inspections.
X ..
12) All building permits a final inspection performed and approved by the Mason County Building Department prior to permit expiration. The
failure to request a final inspection or to obtain approval will be documented in the legal property records on file with Mason County as being
non-compliapfi with Mason County ordinances and building regulations.
X
COM2014-00105 Page 3 of 5
13) All permits expire 180 days after permit issuance, or 180 days after the last inspection activity is performed. The Building Official may extend the
time for action for a period not exceeding 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control
of the permit hM
r have prevented action from being taken. No more than one extension may be granted,
X �'..
14) ALL SURFACE WATER AND POTENTIAL RUNOFF WILL BE CONTROLLED ON SITE AND SHALL NOT ADVERSLY AFFECT ANY ADJACENT
PROPERTIE OR INCREASE THE VELOCITY FLOW ENTERING OR ABUTTING TO ANY STATE OR COUNTY CULVERTING/DITCHING
SYSTEM OAY.
X
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 perm it/appi!cation 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
4PERT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. ?
Si natu a Date
OWNER - REPRESENTATIVE - ONTRACTOR
Print Name (Circle one to indlcata)
COM2014-00105 Page 4 of 5
SCE Co
MASON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
Mason County Bldg. III, 426 West Cedar Street
PO Box 279, Shelton,WA 98584
ixsa www.co.mason.wa.us (360)427-9670 Belfair(360)275-4467 Elma(360)482-5269
SPECIAL INSPECTION (SI)& STRUCTURAL OBSERVATION (SO) REQUIRMENTS
/ ,rm 2012 International Building Code
Permit# Project Name
).4/4y/ 4 siZ_ i �q3) :7 � =
Project Address ' Mason County Tax Parcel Nu bed' )L)
Have the responsible Registered Design Professional(RDP)identify all the items which apply to this project&indicate which agency(by NUMBER 1-6,
see below-no X's)is responsible for each SI or SO.See the 2012 IBC for further info.
IBC RDP SIA SO IBC Section Title
Section (Number (Number
only) only)
1705.1.1 Special cases list cases here-includes suspended ceilings).
1705.2.1 SE Structural Steel,(see tables per AISC 360-if required include in
1 Structural Plans).
1705.2.2 SE Steel construction other than Structural Steel,(see Table 1705.2.2-if
required include table in Structural plans).
1705.3 SE Concrete construction,(see Table 1705.3&WAC table 170S.3-if
required include table in Structural plans).
1705.4 SE Masonry construction,(see Tables per TMS 420/ACI,530/ASCE 5&
TMS 602/ACI 530.1/ASCE 6 if required include tables in structural
plans).
1705.5 SE Wood construction.
1705.6 GEO Soils see Table 1705.6-if required include table in Structural plans).
1705.7 SE Driven deep foundations,(see Table 1705.7-if required include table in
Structural plans).
1705.8 SE Cast-in-place deep foundations(see Table 1705.8-if required include
table in Structural plans),
1705.9 SE Helical pile foundations.
1705.10.1 SE Structural Wood for Wind Resistance.
1705.10.2 SE Cold-formed steel light-frame construction for Wind Resistance.
1705,10.3 SE Wind-resisting components roof or wall cladding).
1705.11.1 SE Structural Steel for Seismic Resistance.
1705.11.2 SE Structural Wood for Seismic Resistance.
1705.11.3 SE Cold-formed steel light-frame construction for Seismic Resistance.
1705.11.4 SE Designated seismic systems.
1705.11.5 Arch NA Architectural components.
1705.11.6 ME NA Mechanical and Electrical components.
1705.11.7 SE I Storage racks.
1705.11.8 SE Seismic isolations stems.
1705.13 Arch NA Sprayed fire-resistant materials.
1705.14 Arch NA Mastic and intumescent fire-resistant coatings.
1705.15 Arch NA Exterior insulation and finish systems(EIFS).
1705.16 Arch Fire-resistant penetrations&joints by Mfg representative.(There are
NO WABO certified personnel in this area yet).
1705.17 ME NA Smoke control.
1704.5 SE NA Structural Observation in Seismic Design Category D areas when a
structure is a Occupancy Category III or IV structure or over 75'AFG
AGENCIES AND REGISTERED DESIGN PROFESSIONALS
WABO approved special Inspection agencies(SIA-PRINT)
SIA 1 �fG-11 yr7 (.y�^�-t[ #i,�. "s L7' AvJ 5 9 3 3 5 73--JjOe)
Registered design professional(RDP)in responsible for structural observation(SO)
RDP 3 RDP 4
Registered geotechnical engineer(GE)in responsible for inspection of soils
GEO 5 GEO 6
SIGNATURES
Registered Design Professionals As the design professional in responsible charge of a portion of this project I have made a reasonable effort to note all
required special inspections and structural observations for that portion of the project. *All are required.
Name (print) Signature Date
*Arch
GEO
ME
*SE
**Owner ]Agent
** Ekwp-re-ted The signature of the caner r owner's agent rely indicates that he or has form.
ABBREVIATIONS
Arch architect GEO geotechnical engineer
IBC International Building Code ICCES International Code Council Evaluation Services
ME mechanical engineer MCBD Mason County Building Department
RDP registered design professional SE structural engineer
SI special inspection(IBC 1704) SIA special inspection agency
SO structural observation(IBC 1710) WABO Washington Association of Building Officials
SPECIAL INSPECTION&STRUCTURAL OBSERVATION TASKS
OWNER OR OWNER'S AGENT:
-The signature of the owner or the owner's agent merely indicates that he or she has reviewed the completed
SI&SO form.The definition of the agency relationship(see 1704.1)is beyond the score of this form.
-Attend preconstruction meeting on SI and SO if required.
DESIGN PROFESSIONALS:
Include in the contract documents the information on SI,SO and quality assurance required in Chapter 17
-Obtain a copy of
County Annex.Complete the form and give a signed copy to the permit applicant prior to permit application.
-Attend preconstruction meeting on SI and SO if required.
PERMIT APPLICANT:
Verify that the inspection agency is registered with WABO by checking the website:http://www.wabo.oro/soecialinspection-agencies
Submit certificate for fabricators approved by ICC Evaluation Services htto://www.icc-es,QfgL(This eliminates the
need for special inspection of shop fabricated components.)
CONTRACTORS:
-Submit certificate of approval by ICC Evaluation Services if a fabricator supplying items requiring SI has ICCES
approval if required.
Coordinates SI and SO and provide a copy of all required reports to the Mason County inspector
Maintain records of all SI and SO
Correct any non-complying items noted during SI or SO
SPECIAL INSPECTION AGENCY
Attend preconstruction meeting on SI if required.
Furnish inspection reports to the Mason County Building Department and provide a copy on site for inspection and RDP
Bring to immediate attention of the Mason County Building Inspector and RDP,any discrepancies which are not corrected by
the contractor.
-Submit final letter documenting special inspection and resolution of all discrepancies to the Mason County Building Department at
PO Box 279,Shelton,WA 98584/FAX: (360)427-7798
Page 1 of 1
KMzx1&Assoeiates, lnc. Field
Geotechnical Engineering•Environmental Engineering Report NO.: 10615197DFRI0262015CW
Construction Testing and Inspection
DATE: 10/26/2015 Set Count: CONTRACTOR: American Tower
PROJECT#: 10615197 PERMIT#:
PROJECT: SE72XCO32 Allyn INSPECTOR: Chaz Woo
LOCATION: 19941 E State Rte 3 JURISDICTION: Mason County
KA P.M.: Wes Mahan WEATHER: Cloudy TEMP:55'F
A representative of Krazan and Associates arrived onsite for the installation of mounted Sprint panel antennas. 1
reviewed the construction plans by Lynx issued 6/17/14 while onsite.
Upon my arrival,the three(3)mounted Sprint panel antennas were already installed by the contractor. From my
observation from the ground,the proposed antennas were installed on the top platform at the appropriate locations based
off the"Proposed Antenna Configuration"detail on A/1117-1.
To the best of my knowledge,the antennas installation appeared to be in general conformance with the approved
plans,specifications,and regulatory requirements.
Reviewed By: AS'1'M Test#: Asset Number(s):
To the best of my knovffedge,the above WAS performed in accordance with the approved plans,specifications and
regulatory requirements.
Su erintendent/Re resentative: Technician:
Offices Serving the Western United States
Lynnwood (425) 485-5519• Poulsbo(360) 598-2126 • Puyallup(253)939-2500
I he df—,Wion p.0dad wt Ihit repw it prcpmwl f x tl+r ausire uuoflhc elicm Thia q w ma)not be npnd.—d m an}ko-t wuhpn the 111dtm P--k n of the ch d and Kr.—R,1.w. 11s They,Wn
mdi.wh —m Nclws obi—anoa AM hiliny r yuhs bud on anr`condawns and contran"acin sm I his 1uf mv.,n It subjact M,,i-pndr Id final snb-nal Oa 4%.i"th,s VM.our tng-lot dart my accept
rcapnnuhdiq f.r,AM,or hi 11.tank to"'111:IIWIl bay Nla P—IdA bt at—on the
o ' cn
o CONCRETE MECHANICAL MANUFACTURED HOME
Date By Footings !Setbacks Gas Piping Ribbons Z
o Interior Date By interior-Date By Date gy WT
V
� Exterar Date By Exterior-Date. B Set-up rrl
Point Load 1lsolated footings INSULATION Date By 0
BG/SLAB INSULATION
Date By Data By FIRE DEPARTMENT C
Foundation Walls Floors Date By
Date By Data By DECKS
F RAM I NG Walls Date By
Date By Data By PROPANE TANKS
PLUMBING vault Date By
Date 13y OTHER
Groundwork Attic
Type:
Date By Date By Date By
D.W.'V DRYWALL Type: n
Gate B Int Brace Wall Date By 0
y Date By N
FINAL INSPECTION
Water Line Fire Separation
Bate By Date By Date i'Z /f By (—A�
O
Pass or Request Inspect.
Type of Insp. Fail Date Date Done By Comments
I✓ta P4
,v
m
tr
0
Cn
Permit f r^l
MASON COUNTY
BUILDING 111 426 W, CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRECTION NOTICE
Job Location l lygl 25 9 lP4'
This structure has been inspected by Mason County Building Department
and the following VIOLATION of County Laws and Ordinances has been
found: Items listed below must be corrected to gain compliancy
A/J yGi e4v�c'� �,�GL e'S S, �J� �Lt 1S✓ 'E%1•C�l.�
t
0
You are hereby notified that the above corrections shall be made
BEFORE PROCEEDING WITH ANY FURTHER WORK
Call for re-inspection when corrections are made before continuing ❑ please contact our office
Make corrections, items will be checked on next inspection regarding possible structural
❑ OK to damage incurred by recent
"natural/man made"
❑ This is not a complete inspection disasters.This is Not a
Date I Department L CORRECTION NOTICE.
Inspector DIiiav N*jT R i0t v4 ; ' THImlb, Two
IVLY N X
July 1, 2014
Mason County
Department of Community Development
426 West Cedar Street
Shelton, WA 98584
RE: SE72XCO32/ATC 310513— Building Permit Application
Hello,
Please see enclosed for your review and approval:
• One (1) Building Permit Application
• Two (2) Structural Analysis
• Two (2) sets of full size Construction Drawings
• Check #3088 for BP Fee of$633.56
If you have any questions, please feel free to call me at 253-653-9787.
Best Regards,
ouvila, ! rf/ g!
RECEIN
Olivia Wright ��� n ��
Project Manager 4,
Lynx Consulting 426 W. Ct=DHi ,�,T,
17311 1351h Ave NE
Suite A-100
Woodinville,WA 98072
owright@Iynxconsulting.org
1 I P a g e 17311 135`h Avenue NE, Suite A-100, Woodinville,WA 98072
111 xq'T7,
f,t
Memo
To: Mason County
From: Christine Contreras
Date: 8/23/2013
Re: Building Permit Application for SE72XCO32 Allyn-Murphy (Sprint MW)
Enclosed, please find enclosed the building permit application for the above
mentioned Sprint Spectrum wireless site(s). Please acknowledge receipt of this package
by signing below and faxing (206-260-7930) or emailing to
ccontreras@rykaconsulting.com.
Received y Mason Coun
Signatur .
_W'kW_A
Date Rec'd: gfrD If 3
Permit Application #:60M zo�—��'
Sincerely,
Christine Contreras
Ryka Consulting on behalf of Sprint Spectrum
206.523.1941
Ryka Consulting ( 919 S. Horton St #1002 Seattle, WA 98134
Page 1 of 1
Trish Woolett - COM2014 00105
From: Aileen Zavales <Azavales(a,lynxconsulting.org>
To: "tw@co.mason.wa.us" <tw@co.mason.wa.us>
Date: 8/6/2014 3:57 PM
Subject: COM2014 00105
Hi Trish—I am taking over for Olivia who is out on maternity leave until the first of the year, early but is all good!
The estimated value of this project is$10,000. Please let me know fees due and how to arrange for payment; may I pay
over the phone with VISA or is it best to send a check? Thanks!
Alleen
Aileen Zavales I Lynx Consulting, Inc.
17311 135th Ave NE,Suite A-100,Woodinville,WA 98072
Cell 206-972-1368 1 Fax 425-354-3277 1 azavales@lynxconsulting.org
ML N Connect to the Future
file:///C:/Users/TrishW/AppData/Local/Temp/XPgrpwise/53E2507FMasonmail 1001626136E 14D... 8/12/2014
f
�tLY N X
August 25, 2014
Mason County
Department of Community Development
Mason County Building III
426 West Cedar Street
Shelton, WA 98584
Attention: Permit Technician/Mary
RE: Sprint— Building Permit Application at 19941 E State Route 3, Allyn
Parcel No. 12217-22-00032 (Sprint 310513)
Hello,
Per our telephone conversation today, in which you said the there was an outstanding
balance of$65.60 for the above referenced permit, enclosed is our check in that
amount.
We would appreciate you sending us a copy of the approved permit at your earliest
convenience; scan and email would be fine: AzavalesAlynxconsulting.org. Please let
me know when we might anticipate seeing that?
Thank you for your consideration.
Si erely,
c
Ai een av e
206 972 13
AzavalesAlynxconsulting.org
LYNX CONSULTING, INC.
1 I P a g e 17311 135`h Avenue NE, Suite A-100, Woodinville, WA 98072
-Co. Page 3 of 4 2014-08-27 00:09:19 (GMT) From: Lynx Consulting Inc.
L L
N Y :
N.
TO: Mason County,Permit Center via FAX 360 427 7798
FROM: Lynx Consulting, Aileen Zavales
RE; Building Permit Request for Sprint at 1.9941 E. State Route 3.,Parcel 12217 22 9Q032
Hi Permitting Department,
,We are trying to pin down an approval date.for the above referenced permit.
Our records show it was submitted to the County on 7/2/2014(a copy of the fed ex receipt is
attached); and we were told that it was not received by the County until 7/29. Could this have been..
confused with a different permit application?
.My coworker,Olivia.Wright,is out of the office until the first of.ycar and I'm assigned to
ullin trackin he
p,.., ....gl..... g.,...r.;}Qbs; !.will be subirutting all future.Mason bounty grlects,
Does it hel c if we do an in-person submittal rather than fed ex, ould it.have been..lost?
P
My conta,ct.infornnation is: Phone 2Q6 972.1.368,.Fax is.425 3.54 3.277, and my email is
Azayales@lynxconsultinl;.ora,
Thank you for your assistance and I look forward to hearing from you.!
Aileen Zavales
l I Page 17311 135`h Avenue NE, Suite A-100, Woodinville; WA 98072
To: Page 4 of 4 2014-08-27 00:09:19 (GMT) From: Lynx Consulting Inc.
TLies 7/01/2014 /20;
Weci T/0212014 2:35 pm
Lynx Consulting. Mason Count~/
Delivered
17311 1:35th Ave NE Syvsci(.e ry. ryOC-i r-E
Suite A-100 426 West Cedar Street
VVD..Lidi kvifle:VIA US 138C72 Sh iton,WA U5 138584
206 30?-578_ E wo 4 7-9870
r"Z1i �►r/1 iTissi .� MORIF"t WONTifi111,^ More actx0n8 r
Let us tell you when your shipment arrives. Sign up for delivery notifications .
Tavel History rTia -,_
.DateMirle Activity Location
- 7102j2014 - Wednesday
sday
2.3S pf;, tM:ec cn.1 AA
n.4,4 am ;'n,Fed Ex�.eNcl4 for deii ver '+;;4.
G 1_f an; A#local .PeCE(facility DLT'1-16t'.Ak.
- V0112014 - Tuesday
1:�r,Om Left Fee,Ex o6;in facility
7:29 pm A °¢d at F€dt::X locancn
r,.0'2 PM Picked U r:=0 t10r .
5:2^pri In t=ed> %possession 'ArjO tNYLLE WA
5.22 p SNpment inform atran sent to FedEx
Select I me zone Local Scarf Time
Shlpmcnt Facts ;
Tracking number 7704-84$3f224 Service i=edEx Grouno
Reference Sprint 310513 Weight 1 lbs
Delivery attempts 1 Total pieces 1
Terms Not Available Packaging
4F
MASON COUNTY PERMIT NO.
y^
\~ DEPARTMENT OF COMMUNITY DEVELOPMENT
BUILDING•PLANNING• FIRE MARSHAL
WWW.CO.MASON.WA.US (360)427-9670 Shelton ext.352
Mason County Bldg. III,426 West Cedar Street (360)275-4467 Belfair ext. 352
PO Box 279, Shelton,WA 98584 (360)482-5269 Elma ext. 352
BUILDING PERMIT APPLICATION
OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: NAME:
MAILINJGJAD RESS:i1` J?,S f , j(x`• MAILING ADDRESS:
CITY:► Y{� j� STATE: ikY, ZIP: CITY: STATE: ZIP:
PHONE: CELL:)53-(05S- PHONE: CELL:
EMAIL:O\ . i-iC`.tY - I Vta-1 j1hm,t71 EMAIL :
L&I REG# EXP.
PARCEL INFORMATION:
PARCEL NUMBER(12 DIGIT NUMBER) FIRE DISTRICT
LEGAL DESCRIPTION(ABBREVIATED): Z2
SITE ADDRESS \CNC CITY �/\
DIRECTIONS TO SITE ADDRESS
IS PROPERTY WITHIN 200 FT:
SALTWATER❑ LAKE ❑ RIVER/CREEK❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF❑ STREAM❑
DOES PROPERTY HAVE SLOPE(S)WITHIN 300 FT OF THE PROJECT-GREATER THAN 14% YES[] NO
TYPE OF JOB: NEW ❑ ADDITION ❑ ALTERATION REPAIR❑ OTHER ❑
USE OF STRUCTURE(RESIDENCE,GARAGE ETC.)
IS USE: PRIMARY SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHRbOMS
DESCRIBE
S QUAR4FOOTAGE: J
IST 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
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
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 constr ction work is suspended for a period of 180 days.PROOF OF CONTINUATION OF WORK IS BY MEANS OF
INSPE TION. ACTIVITY-fF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
x -III I I\A
na ure of Applicant D eateat
X—OU10L, l,CIA6hL OWNER/ RESENTATI\/E,/CONTRACTOR
Print Name S INDICATE)
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT j
PLANNING DEPARTMENT
FIRE MARSHAL
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MASON COUNTY PERMIT NO. H
DEPARTMENT OF COMMUNITY DEVELOPMENT 00135
BUILDING•PLANNING•FIRE MARSHAL
WWW.CO.MASON.WA.US (360)427-9670 Shelton ext.352
Mason County Bldg. III,426 West Cedar Street (360)275-4467 Belfair ext.352
1851 _ PO Box 279,Shelton,WA 98584 (360)482-5269 Elma:P44-i3?
BUILDING PERMIT APPLICATION
OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:ijAm (`,r►) t')l1 NAME: O
MAILINDDRESS: .2>A1 VSS}h AV. L "k 100 MAILING ADDRESS:
CITY:j t',fy kftA Jk,STATE:�`�ZIP: ")- CITY: STATE: ZIP:
PHONE: CELL ADS-Z'-i'm PHONE: CELL:
EMAIL:Qt-C,`i & k flfd.Q)4 EMAIL :
L&I REG# EXP.
PARCEL INFORMATION:
PARCEL NUMBER(12 DIGIT NUMBER) FIRE DISTRICT
LEGAL DESCRIPTION(ABBREVIATED): r
SITE ADDRESS VNC CITY
DIRECTIONS TO SITE ADDRESS Cal
IS PROPERTY WITHIN 200 FT:
SALTWATER❑ LAKE ❑ RIVER/CREEK❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF ❑ STREAM❑
DOES PROPERTY HAVE SLOPE(S)WITHIN 300 FT OF THE PROJECT-GREATER THAN 14% YES❑ NO
TYPE OF JOB: NEW ❑ ADDITION ❑ ALTERATION'S REPAIR❑ OTHER ❑
USE OF STRUCTURE(RESIDENCE,GARAGE ETC.)
IS USE: PRIMARY ❑ SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
DESCRIBE WORK S i
SOU FOOTAGE:
1ST 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
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
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 con�. ACTIVITY
ction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OF
INSPE TION -PF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
x J
na ure of Applicant Date
X—MmOL t,G"t16hL OWNER/ RESENTAT1 -i/CONTRACTOR
Print Name J INDICATE)
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT 7Aha
FIRE MARSHAL
t 1 I 1
NOTE. CLIENT:
THIS IS NOT A SURVEY. ALL INFORMATION AND TRUE NORTH
HAVE BEEN OBTAINED FROM EXISTING DRAWINGS AND
JURISDICTICNAL GIS INFORMATION AND ARE APPROXIMATE.
Sprint
CUEN7:
EXISTING ADJACENT N
PROPERTY LINE TYP�
\ AMERICAN TOWER
j
IMPLEMENTATION TEAM/CLIENT:
EXISTING PROPERTY LINE YLYNX
I
\ g p'r'D WTI
PLANNING■ INGRESS POINT S
\f� INGRESS AND EGRESSR1ASy! f
ALL SETBACKS ARE MEASURED \yC,
FROM THE FURTHEST s
PROJECTION OF THE BUILDING I \4;� �� J
PROD
�p 51134EX STING
I ACCESS RO DEL
SIONAL
I \ \ REV DATE DESCRIPTION
MG \\
APPROVED \`2� 2 7/01/14 ISSUED FOR SUBMITTAL
MASON COUNTY DCD PLANNING
REQUIRED TO BE ON SITE
1 6/I8/14 ISSUED FOR REVIEW
SITE PLAN w I \
CHANGE UBJECT TO APPROVAL \ DO NOT S DRAWINGS.CONTRACTOR VERIFY ALL
AND ANY
DRAWINGS AND ADVISE CONSULTANTS OF ANY ERRORS OR
C OMISSIONS.NO VARIATIONS OR MODIFICATIONS TO WORK
A-1 SHOWN SHALL BE IMPLEMENTED WITHOUT PRIOR WRITTEN
Date APPROVA.ALL PREVIOUS ISSUES OF THIS DRAWINGS ARE
I 1 SUPERSEDED BY THE LATEST REVISION.ALL DRAWINGS AND
By x c SPECIFICATIONS REMAIN THE PROPERTY OF LYNX CONSULTING,
l i'• U6 ' ( ENGINEER
WILL BE PEROVIDNG CONSTRUCTION REVIEW OFCONSULTING,INC.NOR ETHIS PROJECT.
i f PROJECT:
i I
x x SE72XCO32
i �? ALLYN
1 X i I�
r 19941 E STATE RTE 3
e _s'`EXISTING 148'-0• I�I MONOPOLE ALLYN, WA 98524
EXISTING WIRELESS
ICOMPOUND (t2,304 SF) I x SHEET TITLE.
I PROPOSED
I 1
SITE PLAN
EXISTING PROPERTY LWE — — —
PROJECT NUMBER: DATE:
2014010201 6/17/14
DRAFTER: PROFESSIONAL OF RECORD
CAL BEW
REVISION NO- SHEET NO:
•x17 SCALE. 1• 40-0• PROPOSED SITE PLAN 1 2 C
11•Xn• SCALE-- 1•= so'-o• 40i zo' o' 40•