HomeMy WebLinkAboutCOM2019-00126 Exhisting Wireless Facility - COM Application - 12/26/2019 MASON COUNTY COMMUNITY SERVICES Permit No:( /)r'Yl�I—t• ��Z
PERMIT ASSISTANCE CENTER:
-BUILDING-PLANNING-PUBUC HEALTH-FIRE MARSHAL RECEIVE
615 W.Alder Street,Shelton,WA 98584 IL.%
Phone Shelton:(360)427.9670 ext.352-Fax:(360)427-7798 Phone
Betrair:(360)275-4467-Phone Elma:(360)482-5269 DEC r L^ b^ 2019
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR IN FORMA W. Alder Ste(
NAME-MARY BORDEN NAME:TBD
MAILING ADDRESS:34D N ANCHOR DRIVE MAILING ADDRESS:
CITY: BELFAIR STATE:WA ZIP:98528 CITY: STATE: ZIP:
PHONE#I: PHONE: CELL:
PHONE#?: EMAIL:
EMAIL: L&I REG# EXP.
PRIMARY CONTACT: OWNER❑ CONTRACTOR❑ OTHER
NAME Natasha Montalvo.Crown Castle,on behalf of AT&T EMAIL wnwsde.com
MAILING ADDRESS-1505 Westlake Ave N Ste 800 CITY SEATTLE STATE WA ZIP 98109
PHONE 206,nG.28e6 CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 4-20-16-32-90300 ZONING IH
LEGAL DESCRIPTION(Abbreviated) NW SW EX LOT:C OF SPtt 2693 FIRE DISTRICT
SITE ADDRESS 300 WEST CHAPPELL CROSSING CITY SHELTON
DIRECTIONS TO SITE ADDRESS SEE CONSTRUCTION DRAWINGS PAGE T-1
1S THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NOV
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: lCheckallrhmappl0: NIA
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW❑ ADDITION❑ ALTERATION V REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence.Garage.Commercial Bldg,Etc)EXISTING WIRELESS FACILITY
IS USE: PRIMARY V SEASONAL❑ NUMBER OF BEDROOMS NIA NUMBER OF BATHROOMS NIA
HEATED STRUCTURE? YES(whole Bldg)❑ YES(Part(sl ofaidg)❑ NOV
DESCRIBE WORK MODIFICATION TO AN EXISTING WIRELESS FACILITY -ANTENNA SWAP
SOUARE FOOTAGE:owposer0 N/A
I ST FLOOR sq.ft. 2ND FLOOR sq.III. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft. Altached❑ Detached❑ CARPORT sq.ft. dllached❑ Detached❑
MANUFACTURED HOME INFORMATION: N/A *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH: N/A
SEWAGE/SEWER SOURCE: SEPTIC❑ SEWER❑ / NEW❑ EXISTING❑
PLUMBING IN STRUCTURE? YES❑ NO❑ I()-es,attach completed Water AdequaiZv Fonn
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 slop work order or permit revocation.Acknowledgement of such is by I
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 Courtly access to the above described property
and structure(s)for review and Inspection. This permll/application becomes null 8 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 APP. (CATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
X ,�' ? _� December 11, 2019
—?�IgrtaWro o(O R(Muctbe alined by the OWNER) Date
-"DEPARTMENTAfREVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH
- at&t
// FATLANTA,
OROSGO DRIVE
1 2 GA 30324
APPROXIMATE L
OCATION
CROWN
/►OF PROPERTY LINE V ROW N
RECEIVED
E CASTLE
(E)ACCESS ROAD
✓ 1505 V-ESTLAKE AVENUE NORTH,SUITE 800
��s✓ ��\\ V 1 SEATT-LE,NVA 98109
I ,��1',✓✓' { DEC 2 6 2019
4 I (E)
AT&T EOUIPENT PAD
(E)COMPOUN( 615 W. Alder Street (�VTE
F. (E)150'-0"MO POLE �"`E L...•�•:.,•..
I W CHAPPELL CROSSING /
7150N HIGLEYRD-SLOG 2,SUITE 102
MESA.AZ&5212,5
(E)SITE LOCATION
(REFERENCE C-1.2 FOR DETAILS) P L
MANN NJ
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rRFDS DATED 6/6/2017 v2.00
0 AT&T SITE NUMBER: OL42
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w BU#: 855647
k o -•--PLANNING: DAYTON
' I APN:4201632900300 I i
a ZONING:IH a 6018 WEST
ALL SETBACKS ARE MEASURED SHELTON-Mi-VTLOCKROAD
FROM THE FURTHEST SHELTON,WA 98584
PROJECTION OF THE BUILDING
EXISTING 150'-0"MONOPOLE
APPROXIMATE LOCATION OF PROPERTY L INE
ISSUED FOR:
REV DATE DRWN DESCRIPTION DES./QA
A 12/12/19 J-Nt PRELINILNARY'CDs CAV
0 12/20/19 AK SUBDOTTAL CDs C\\-
V �L'
'7FL plEX 0
qT C g
kRo APPROVED S����•�
MASON COUNTY DCD PLANNING �*
SITE PLAN REQUIRED TO BE ON SITE SxONED,20 DEC 2010
IXPIRES,3 FEB 2020
C N SUBJECT TO APPROVAL
BY Date v G
IT IS A VIOLATION OF LAW FOR ANY PERSON,
-.-�LESS THEY ARE ACTING UNDER THE DIRECTION
OF A LICENSED PROFESSIONAL ENGINEER,
TO ALTER THIS DOCU.fMNT.
1 OVERALL SITE PLAN SHEET NUMBER: VISION:
I SCALE: — ,"•ev�(E�vsI2E,
C- 1