HomeMy WebLinkAboutBD2003-01581 Wood Fireplace - BLD Permit / Conditions - 3/3/2003 10/15/2003 08:25 FAX 360 427 7798 MASON CO PERMIT CTR fm001
FORM MUST BE COMPLETED IN INK
PLEASE PRESS HARD PERMIT
MASON COUNTY .
PLUMBING/MECHANICAL PERMIT APPLICATION
42111 W.Ceiaar/p.0
Shelton pa9)4274 BalE11F(Ji0�27S T Einp pwMt92-ilia
w A;1 Lner N O N; CONTRACTOR INFORMATION
� Owner Contractor
Mailing Address o Mailing Address
Phy State W Zip Code City Zip Code
Other Ph.(6�2t 1 Ph.0 Other
LienlT'kle Holder Contrado
Address i /
SEPTIC INFORMATION-Conn tQ New Septcc ExlsUn Septic -onnect to Sewer System Name of
Sewer System— Ay�1
PARCEL INFORMATION-12 digit Tax Parcel No. J Fin District
Legal Description
Site Address(Please include street name,street number and city)
Directions to eke_fIs
��
Your PrGPprtYWkNn 2W'cf the following:Body of Water(Nam)
Lake ✓" RivwlCreek Saltwater
Skrpea Btx =/ Pond Weltered Seasonal Runof Stream
I
TYPE OF JOB New. Add AI Repair Other Use of Building
Location ofFixtures/Units 1st Floor 2nd Floor Basement Gars a Closet
PLUMBING FIXTURES(Show Nu fiber of each) MECHANICAL UNITS Fuel Type: Electric
Toilets F*'m No. ea E LPG Natural Gas Hestpump
Bathroom Sink Furnace EM
Bath Tubs Heatpumps
Showers
Water He" Spot Vent Fan
Clothes Washer &pTaaur0*
Ktchen SkUteDishwasher ust Mood
HoseWbe Other
Bane Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF FIXTURERJNIT.
V
NOTICE:THIS PERMIT BECOMES NULL a VOID IF WORK OR CONSTRUCTION AUTHMM a NOT MEK%=WITHIN in DAYir OR Is
CONSTRUCTION WORK 19 SUSPENDED OR ABAflf 0M FOR A PERIOD OF Ise DAYS AT ANT TIME AFTER TM WORK D COMWy4CED.
PROOF OP Cp 4 rMIUATION OF WORK M tiY MEANS OF A PROOREss INSPECTION.The owner or agent on owhrr's bMtatf,represerhts that the
infomahton io sectinte and grants srrhployess of Mason County access to the above described Property and struauras for review and
Inspah Uen or this projeeL AcknmwledgnteM of such Is by signature below:
OWNER AFFIDAVIT-1 certify that I am amnpt from the raqui Wrw is of the CONTRACTOR'S AFFIDAVIT-I canify that I am currently reyWWW as a
Con WW Ragietl'a8on Law RCW 18.27 and wn awws of the ordnance cahhtnctor in the State of WSW*X ion and that I am swan of the ordinance
nqukwrhsres for WN-this Permit he ieeued and that Y work we be done in re"renwou rapWesnp the vept fw which is issued and ei work
oarfomwnoe therewith No shall be made Without Ant Omsk" shall be done in confar iwroe therewith. No al�ge
aPP al• first ohpMM9 approval. p
Date 11 3 1,01f X pea 7 t� i
FOR OFFICIAL USE BEYOND THIS POINT NOV 5 f '
Accepted by Date Submittal Amount Due Receipt No.00
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Other 77
Other
Permit Fes
Pion Review F UFC Pion Ravlew Fee
Piumbahg a 8 Fee Other
Mechanical a lose FIN Other
WoodGas/Pa at Stow Fee - Pre-Paid at Submittal ( )
Vitiation Fee TOTAL FEES
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Sent By: Mark Ransavage HD; 925 373 7975; Nov-14-03 10:37AM; Page 2/2
11/13/2003 10:03 FAX 360 427 7798 MASON CO PERMIT CTR 14002
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