HomeMy WebLinkAboutCOM2011-00040 Change in Occupant - COM Application - 5/19/2011 MASON COUNTY
TENANT REVIEW APPLICATIO
Complete the Tenant Review Application and return with a floor plan, site plan, septic pumper's re ptic records d $141.917ree to
the Mason County Permit Center, P.O. Box 186, Shelton,WA 98584. During the evaluation of your Tena AppritafiemMaff
members from the Building, Fire Marshal, Environmental Health, Planning and Public Works offices will identify compliance requirements.
This application is intended for tenant change only. If construction or remodeling is proposed/required a separate building permit
will be necessary. Upon approval the permit will be issued to the applicant/tenant. After the permit is issued, schedule a site inspection
by calling (360)427-7262. Upon satisfactory inspection a Certificate of Occupancy will be issued and must be posted in a conspicuous
lace on the premises.
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Date: Assessor's Parcel Number:
Legal Description: 7{6 / 1—
Building Site Address: Q.
Method of sewage disposal: 0 Septic O Sewer—na a of district: �(L,- j.
ao—
Water source: O Individual Well O Community Well O Public System, name of system:
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Name of Applicant:
Mailing address: _
City: State: c� Zip: R�-36( E-Mail Address: . ^-
Day phon AX hone: `G
p Contact Person:
... PROJECT INFORMATION
Proposed business name: $ n ) 7-
L
Proposed use: Number iff irnpl*ees:
Previous business n me:
Describe previous use:Check one: a Detached single level/single tenant O Single level/multi tenant
O Multi level/single tenant O Multi level/multi tenant
Age of structure: Is structure currently If not occupied, how long has it been vacant?
occupied? Yes No Yrs mos.
Square footage: Basement: First:2e Mezzanine: Second: Third:
Is the structure heated? Heating type: Circleg�
Circle one: es No <IfI� Liquid Pro al Gas Oil
Type of hea : Circle one: Furnace Heat Pump ectnc baseboard or wall mo-ynV Radiant
Will there be any changes to the following? Circle yes or no, ifapplicapl
Floor lay-out: Yes > No Lighting: Yes No Heating: Yes
Exterior Finishes: • Yes No Interior Finishes: Yes o Parking: Yes No
Number of restrooms provided: Number of fixtures in each
Is structure handicap accessible? Circle on es No
Is the structure equipped with a fire sprinkler system? Yes No Fire alarm system? Yes No
Monitoring Station Name: Phone number:
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Retur��tI11S,;'PPP atlonklx``;s;y ''
1. Floor Plan(5 sets).
Draw the floor plan to scale 0 Use of rooms
• rRoom 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 I ,
• 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 -
• Surface&storm water run-off routes • Parking areas (number&arrangement)
• Location of fire hydrants&vehicle access roads
3. Septic records,pumper's report or O&M report.
4. Fees will be collected at time of submittal. Balance due will be collected when the permit is approved and issued.
,,Official !Use Only
Accepted by Date Submittal Amount $ Receipt number
Department Review I 'tials Date Comments
Building
Environmental Health
Fire Marshal
Planning
Public Works
Pre Application required? (circle one) Yes No Building Permit required? (circle one) Yes No
Engineering Required? (circle one) Yes No Type of construction
Occupancy Change? (circle one) Yes No New Occupant load: persons
Occupancy classification change from to Valuation: $