HomeMy WebLinkAboutCOM2014-00140 - COM CD Environmental Health Review - 9/25/2014 COMMUNITY DEVELOPMENT ENVIRONMENTALLfHEALT o REVIEW
Ocial Mason County Public Health
415 N. 6th Street Permit Number.
PO Box 16W Date Received; IO-I.2DO
Shelton,wA 98584 ( . ZO t 4
Shelton:(360)427-9670, Ext 400 Amount Received
BeBalr (360)27 .400
El ma. (360)482-5269 Ex:400 Receipt Number
Fax (360)427-7787 Type of Review
Applicant Information
4, ��ly FA0.lA5 Date�tZS-Jt� ❑ Building Permit
Applicant r1 ❑ New ❑ Replacement
Mailing Address t b'
❑ Commercial Building Permit
L. RNi 14 a New ❑ Replacement
city Sate Zip ❑ Building/Commercial Permit Revision
Daytime Phoneifl � __)_`'Other Phon 5T)-ZJ05 ❑ Tenant Review
E-Mail Address' .ehl- ❑ Pre-Application
Parcel Information
12-Digit Parcel Number
Site Address ' sxe N.a,r ca➢
stud Nub.
_641d Please submit a scaled plot plan
Type of Job ff —�" I showing all existing and proposed
Describe work S-
0a ryt P1i 10 n building, on-site sewage system,
Number of Bedrooms Kam_ and well.
e Information Water System Information
QL
a on Sewag Plumbing in structure? XYes ❑ No
On-Site Septic System ❑ New ❑ Existing
❑ Sewer Name of Sewer System — if yes:
Using an existing on-site septic system will require a current Please submit a completed Water
maintenance report and a Record Drawing (Asbuilt). Documents Adequacy Form.
for both of these requirements may be on file with Mason
County Public Health. Other requirements may apply.
Appll nt lgna Date
Official use only
De artrnental Review A roved
Notes
Water Adequacy
On-site Sewage System
0 20
Tenant Review
Revision
COMMUNITY DEVELOPMENT ENVIRONMENTALLfHEALTH REVIEW
Mason County Public Health
oal use only
415 N. 6th Street Permit Number. �—
PO Box 1656 Date Received:
Shelton,WA 9B584
Shelton:(360)427-9670, Ext. 400 Amount Received
e air( )(3 0)
7 9 a005-44 Ext Receipt NumberEl a�
Fax (360)427-7787
Type of Reidew
Applicant information 5129114 Ing Perl
Applicant Evergreen GroPro LLC Date II New uu Replacement
I Mailing Address PMB 321910 E.4N Ave
WA sesoa C�rDmercial Building Permit
�I Nmy I I Replacement
Olympia Zip LJ LLJJ
city state Building/Commercial Permit Revision
Daytime Phone 360.2e0.40a5 Other Phone Tenant Review
E-Mail Address frank eve reen ro .rom V Pre-APPlicebon
parcel information 42002-24-g0070
12-Digit Parcel Number shelve"
Site Address ('r6D) euiltling A3 WesMe10 C1. ch➢
Strm Numbs Strut Nm,m
III please submit a scaled plot plan
Type of Job showing all existing and proposed
'tenant improvement build out building, on-site sewage system,
Describe Work
and well.
Number of Bedrooms_
Water ystem Information
On-Site Sewage Information plumbing in slmcture? LWCJ} es ❑No
zOn-Site Septic System []New 0�xisting if yes:
13 Sewer Name of Sewer System --
Using an existing on-site septic system will require a current please submit a completed Water
maintenance report and a Record Drawing (Asblrilt). Documents
Adequacy Form.
for on
Counoth Of these ty Puti c Health. other requirements equireme file
may IapP y son
Applicant Applicant Signatures Date sa 9n4
Official use only
De arbriental Review
p roved Denied Notes
Water Adequacy
On-site Sewage System
Tenant Review
Revision
r