HomeMy WebLinkAboutCOM2001-00157 Cancelled Tenant Review - COM Application - 2/1/1982 �vrsd
Case number
Mason County
TENANT REVIEW APPLICATION
Complete the tenant review application and return with floor plan. site plan, pumpers report, and $100.00 fee to
the Mason County Permit Assistance Center, attn. M MacSems, P.O. Box 186, Shelton,WA 98584. The tenant review
application will be evaluated on Wednesday after the application has been received. During the evaluation Mason County
staff members from the Building, Fire Marshal, Environmental Health, Planning, and Public Works offices will identify
compliance requirements, if needed, and advise whether a separate building permit will be required.
Date: j a jg p/ Assessor's Parcel Number:
Legal Description: -fie — 15
Building Site Address: 7/0/ 154,s f 5'4-9_e 667 ape,—k44
Method of sewage disposal: O Septic O Sewer- name of district a ar fc,.- T f
Water source: O Well O Community Well • Public System, name of system:
/etas&,, a 1
PEOPLE and FIRMS INVOLVED IN THE PROJECT
Name of property owner: Al,,.AA Lczd „ G_G
Mailing address: 93 q 3 S/9 4. 5, O 7
Day phone: 2S 3 6 9- Contact Person: /9,-, Message phone: 9'6
90 /t4
Name of applicant:
Mailing address:
Day phone: Contact person: Message phone:
Name of Tenant:
Mailing address:
Day phone: Contact person: Message phone.-
PROJECT INFORMATION
Proposed business name: Al6r00/C
Proposed use: tad �Iurn t er e` Mpicy as:
Previous business name:
Previous use:
INFORMATION ABOUT STRUCTURE
Check one: ODetached single level/single tenant si gle level/multi tenant
Multi level/single tenant VMulti level/multi tenant
Age of st ucture: Is structure curre occupied? If not occupied, how long has it been vacant?
KO /q 6 3 !9$7 Circle one: Ye No Yrs mos.
List square footage for each floor level
Basement: First: Mezzanine: Second: Third:
Will structure be heated: I Type heating fuel: Circle one.-
Circle one: esj No I Electric Liquid Propane Natural Gas Oil
Type of heat: Circle one: Furnace Heat Pump Electric baseboard or wall mount Radiant
Will there be any changes to the following? Circle yes or no, if applicable:
Floor lay-out: Ye No Lighting: Yes No Heatin&Ye No
Exterior Finishes: a No Interior Finishes es No ParkinNo
Number of restrooms provided: Number of fixtures in each
Is structure ADA Accessible? circle one Yes No v-v-e q ccessi6le
Is the structure equipped with a fire sprinkler system? Yes No Fire alarm system? es No
_•_ air 461y SiOKM-Ac 4.. 0/ —_
Return this application with:
1) Floor Plan, 2)Site Plan, 3) Pumpers Report, and 4) $100 Fee
1) Floor Plan: Include existing walls,proposed walls,and walls that will be removed.
• Draw the floor plan to scale, %"= 1 foot min. • Use of rooms
• Room Dimensions • Location of all exits and windows (include dimensions)
• Location of plumbing and mechanical fixtures • Interior d—rs�th ,rirlL_r iTfl
,l
2) Site Plan: Note scale 11ll y
• Property lines, easements, & right of ways • LocatioUall existing tr�x{c1�;{{� s &di Lions
• Distance, in feet, from property line &structures Landscape buffo 8 hy,
• On-site sewage tanks and drainfields, & reserve • Well)gcation
• Surface & stormwater run-off routes ParkI AaC( NjWa0 2j
• Location of fire hydrants&vehicle access roads Slope of property
3) Pumpers Report
4) Fee: $100.00:stake fee will be collected when submitted. Additional fees will be collected when the permit is
issued.
Office Use Only
Pre-Application Review Departmental Review ,
Env. Health Env. Health
Planning Planning
Public Works Public Works
Fire Marshal Fire Marshal
Building Building
NREC NREC
Pre Application required? (circle one) Yes No
Building Permit required? (circle one) Yes No Erryineerinri Rn luir,d.?
Occupancy Classification: Occupancy Change? (circle one) Yes No
Occupancy classification change from to
Type of construction
Occupant load calculated: persons. Existing occupant load design persons.
Fee Schedule