HomeMy WebLinkAboutCOM2009-00021 Change in Tenant - COM Application - 3/5/2009 COM ),i_ L_q ✓
MASON COUNTY
CHANGE IN TENANT APPLICATION
Complete the Change in Tenant Application and return with a floor p n,si an,septic pumper's report,septic records and
fee to the Mason County Permit Center,P.O.Box 186,Shelton,WA 98584. Evaluation of the Change in Tenant Application will involve
staff members from the Building,Fire Marshal,Environmental Health,Planning and Public Works offices who will identify compliance
requirements. This application is intended for tenant change only. If construction or remodeling is Proposed or required a building
Permit will be necessary. Upon approval the permit will be issued to the applicant/tenant. After the permit is issued,schedule an
inspection by calling(360)427-7262.Upon satisfactory inspection a Certificate of Occupancy will be issued and must be posted in a
conspicuous place on the Premises.
. RO.p ORJlV _
Date: Assessor's Parcel Number: 2. 2 Z C1 O o
Legal Description:
Building Site Address: r $
Method of sewage disposal: • Septic N O Sewe —name of district:
Water source: O Individual Well O Community Well O Public System,name of system: maned w a�v-
PEOPLE INVOLVED IN THE PROJECT z
7e Name of Applicant: so, -Y f•e t^C�
Mailing address: SD S ✓i 9S
M ! City: State: Zip: 90 d
?j Day phone;42_5 jrqX74.Contact Hers . L,i 4 Message phone L1.2 S 3co6 0 360_1/b7
.. _ P IECT INFORMATION (Er
Proposed business name. e
Proposed use: Number of employees: 1,0 ed
Previous business name.
Describe previous use: E
Egef�SSo
STRUlC7 URE,DETAIL$.,
Check one: 0 Detached singlelevel/single tenant O Single level/multi tenant
O Multi level/single tenant O Multi level/multi tenant
Age of tructure: Is structure currently If not occupied,how long has it been vacant?
G occupied? Yes No Yr. I Mo. a Imo K
Square footage: Basement: First: Mezzanine: Secon
— hird:
Is the struct heated? Heating type:Circe (t I
Circle one: es No lectric Li uid Propane Natural Gas Oil �S ('e5 So Pretc t i K e
Type of heat:Circle one: Furnace Heat Pump Electric baseboard or wall mount Radiant 5 h eo.+ S e s rce—
Will there be any changes to the following?Circle yes or no,if applicable:
Floor lay-out: Yes No Lighting: Re,
No Heatin es No
Exterior Finishes: a No Interior Finishes: No Parking:Yes O
Number of restroorns provided Number of fixtures in each
Is structure handicap accessible?Circle one Yes No
Is the structure equipped with a fire sprinkler system? Ye No Fire alarm system? Yes o"
Monitoring Station Name: 0 jq Phone number: N A
y VPLiGi4"1iOt W( IOTSf3EatlCt t l3 WtT�C !'UT:"
1. Floor Plan(5 sets):
• Draw the floor plan to scale Use of rooms
• Room Dimensions • Location of all exits and windows(include dimensions)
• Location of plumbing and mechanical fixtures • Interior doors with swing radius
2. Site Plan(5 sets): Note scale used
• Property lines,easements,&right of ways • Location of all existing structures&dimensions
• Distance,in feet,from property line&structures • Landscape buffer yards
• On-site sewage tanks and drain fields,&reserve . Well location
• Location of fire hydrants&vehicle access roads I . Parking areas number&arrangement)
3. Septic records,pumper's report or O&M report.
4. Fees will be collected at time of submittal
`offi �1 use Or e ci,
Accepted by Date Submittal Amount$ Receipt number
Department Review ln' ' Date Comments
Building /
Environmental Health
Fire Marshal f
Planning
Public Works
Occupancy Change? (circle one) Yes No Type of construction
Occupancy classification change from to Occupant load calculated: persons
Existing occupant load design persons. Land Use Designation:
Occupancy Classification: