The URL can be used to link to this page

Home My WebLink AboutCOM2007-00072 Cancelled Change in Tenant - COM Application - 12/18/2007 C0MjLQj--6%-zz-- MASON COUNTY CHANGE IN TENANT APPLICATION 00o7a-- i ' ''Complete the Change in Tenant Application and return with a floor plan,site plan,septic pump report,septic records and ers 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 remodelin is ro osed or re aired a butldin permit will be necessary. Upon approval the permit will be issued to the applicant/tenant. After the permit is issued, schedule-R inspection by calling (360)427-7262. Upon satisfactory inspection a Certificate of Occupancy will be issued and must be posted ian n a conspicuous lace on the remises. Date: ' p Assessor's Parcel Number: Legal Description: /�3�Z�OC�C)O Building Site Address: 22S 5,12. Method of sewage disposal: ® Septic z Water source: O Individual Well O Sewer—name of district: O Community Well 0 Public System, name of system: Name of Applicant: � ►g' Mailing address: City: State: Day phone:y53 3�f� Zip: SSA/t Contact Person aN Message phone:2 �Proposed business name: 15 376 Proposed use: 17 Number Previous business name: of L employees: Describe previous use: / NT Check one: • Detached single level/single tenant O Single level/multi tenant O Multi level/sin le tenant Age of structure: 0 Multi level/multi tenant Is structure cur tl If not occupied, how occ led? Yes No Yr. long has it been vacant? u Square footage: Basement; irst: Mo. Is the struct heated? Mezzanine: Second: Hea ing type: Circle /4 Third: Circle one: es No ' Type of hea : Circle one: Furnace Heat P cfri Li aid Propane Natural Gas Electric baseboard or wall mount Radiant Will there be any changes to the following? Circle yes orno,if applicable: Floor lay-out: Yes No Lighting: Yes No Exterior Finishes: Yes No Interior Finishes: Yes No Heating:. Yes No Number of restrooms provided N : Parkin : Yes No Is structure handicap accessible? Circle on uYes r of fixtures in each i 1 Is the structure equipped with a fire sprinkler system? Yes No Z"R�q1. I� "` o ti 2 C�•awQp� Monitoring Station Name: Fire alarm system? Yes No Phone number: 1• Floor Plan(5 sets): • Draw the floor plan to scale • Room Dimensions 0Use of rooms • Location of lumbin and mechanical fixtures • Location of all exits and windows (include dimensions) 2. Site Plan(5 sets): Note 5-;:Z used • Interior doors with swing radius • Property lines, easements, right of ways • Distance, in feet,from props:,ty line&structures • Location of all existing structures&dimensions • On-site sewage tanks and drain fields. e, reserve • Landscape buffer yards • Location of fire hydrants&vehicle ar, roads • Well location 3. Septic records,Pumper's report<s; , ;.:.- report • Parkin areas number&arran ement 4. Fees will be collect Fat time of s'..; / Accepted by Date Submittal Amount$ • Receipt number De artment Review Initial Building Building Date Comments Environmental Health - �O Fire Marshal , Planning Public Works Occupancy Change? (circle one) Yes No �)Occupancy classification change from Type of construction VT __ to Occupant load calculated: / Existing occupant load design persons. persons Occupancy Classification: -----__persons. Land Use Designation: MASON CWNTY PERMIT NO. BUILDING PERMIT APPLICATION 1 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 Shelton (360) 427-9670 • Belfair(360) 275-4467 • Elma (360) 482-5269 . , On the web www.co.mason.wa.us APPLICANT INFOIMATION CONTRACTOR INFORMATION Owner _N Z S• VIC•avw+4" Company Name Mailin Address Z QT Mailing Address City 4f A 1 4- State U A Zip Code City State Zip Code j Phone z s a ? 77 QqJ? ! Other Ph. . 8S SZ T9/ Phone Other Ph. Lien/Title Holder o 0 • A Contractor Reg. # Exp. E mail address �'Lg/J ",e .A)&r E Mail Address Drivers Lic.# cDWRbYJ'3 DOB /Zy2Zjga I Drivers Lic.# DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic &—"` Connect to Water System _';: Name of Water System i24 A'AUu,R Well Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. Fire District Legal Description P7A1 oF Lo7 31 SA-M 6. ZRLEks No e A N b 67 &� Site Address (Please include street name, str t number and city)ZZ RT.3 k i'41 f s SZB Directions to site dA-'&*T 2 , Z-Nz Will timber be cut and sold in parcel preparation?Yes Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB - New Add Alt Repair Other ,esmew/C. PRIMARY RESIDENCE ❑ SEASONAL ❑ Use of Building '��'" / � Describe Work t-,P AJ >auJ 1424A�jm"'.e°s No. of Bedrooms '—" " No. of Bathrooms -4,1 Square Footage- 1st Floor 2nd Floor 3rd Floor Basement Deck Covered Deck Other Sq. ft. Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make Model Year Length Width No. No. of Bedrooms No. of Bathrooms Type of Heat - Purchas F"e,0$ Replacement Unit? Yes/ No Installer Name Certification No. 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 the contractor. I further declare that I am entitled to receive this permit and to do the work as proposed in the application. I declare that I have obtained the permission from all the necessary parties. If permission is required from any easement holder or any other party in interest regarding this application or the work proposed in the application, I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf, represents that the informaticn provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection. This permit/application 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 OFAP OGRESS INS T INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. X Date: Owner/Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department Fire Marshal FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing & Base Fee Planning Review Fee Mechanical & Base fee Other Wood/Gas/ Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES 1 Request To Rervise'An'Approved Plan C:ol-M06(1. 00'12- Permit Number: BtFY2 0 - Name �,,J,,AOA4 Parcel Number 10 - QC019 Phone Number Mdavt*Project AddressMailing Addres Please provide a complete, detailed description of the proposed revisions to the approved plans: ns Are two sets of the revised plans or addendum indicating the ch �161:d? Yes No"'MW ange Are the approved site plans included? no j' Lti— j9wh ❑ Yes ❑ No Are the revisions clearly and accurately identified on the plans or addendum? ❑ Yes ❑ No Does the plan contain an engineer's or architect's lateral or vertical analysis? ❑ Yes D No If Yes, Has the engineer or architect approved this revision? ❑ Yes ❑ No Is a stamped and signed approval included with this request? ❑ Yes ❑ No (Note:No structural changes to a"designed"plan will be approved without the written consent of the engineer and/or architect of record.) Does the proposed revision modify the footprint or location of the structure? W"Y"es ❑ No If Yes, Is a revised s('te plan,with all new setback dimensio s included with this request? W 5�44 n o n —rzr2A m+ reu 1 ❑ Yes ❑ No uw - Additional fo ation: Rd n Ln r Applicant's signature Date: Office Use Only Received by: Date Sent Assigned To Approved By Date ❑ B. �� Original Valuation: $ Additional Valuation: $ ' a-_::5 O—czil r 1 Z�3�f7'1 Sq.Ft. x$ $ D UCILS Sq.Ft. x$ $ } t, i! -TU.) I l /�� Total New Valuation $ 'T �f Additional Fees: Additional Planning Dept. $ Additional Plan Review $ Additional Conditions/Comments: Additional Building Permit $ Additional Plumbing $ Additional Mechanical $ Additional E.H. Dept. $ Other $ Total Amount Due: $ Amount To Be Paid Up-Front$ PLANNING: ALL SETBACKS ARE MEASURED FROM THE FURTHEST r PROJECTION OF THE BUILDING J i PLANNING APPRO VED --- MASON s�7E PLAN DCD PLANNING AN REQUIRED 7p CHANGES SUBJECT 70 APPCN SITE gy R�OyAL Date t �-1 13107 Int f 1 wow v ��1 xi r' 44 mv DOW 1