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1097 SalbeCk MECHANICAL MOBILE HOME
by date by Ribbons
Foundation Ways Gas Piping date by
by date by Set Up
INSULATION date by
InsAAadon by Floors Final
date by date
FRAMING Wags FIRE DEPT.
date by date by date by
PLUMBING OTHER
Groundwork Attic
eby date by
D.W.V. WALLBOARD NAILING
e by date by
tine FINAL INSPECTION
date by date —Zd--OZ by �L date by
M ACE Ni ,(r L ri4/LF,o l 111B)0z
I
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I
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Y
E
FORM MUST BE COMPLETED IN INK PERMIT N ` . V
PLEASE PRESS HARD MASON COUNTY E D
PLUMBING/MECHANICAL PERMIT APPLICATIOML 2 2 2001
426 W.Cedar/P.O.Box 186,Shelton,WA 98584
Shelton 360 427-9670 Belfatr 360 275-L467 Elma 360 482-5269 Seattle 206 464-6968
APPLICANT INFORMATION CONTRACTOR INFORMATION 1
Owner �1121giQE• Pos Contractor Name
Mailing Address ft``v Mailing Address
City ALLY1 j State WA Zip Code City State Zip Code
Phone�� a t�-h�ey,�Ph.0 Ph Other Other Ph.(`�
Lien/Title Holder WFCLS E 4 d Contractor Reg. #
Address Expiration
SEPTIC INFORMATION-Connect to New Septic Existing Septic_ )!�,_Connect to Sewer System Name of
Sewer System
PARCEL INFORMATION-12 digit Tax Parcel No. z2 / Z O _/ Fire District
Legal Description
Site Address(Please include street name,street number and city) /16041C-
Directions to site _/l�f�' +Q/�I t'�..• r-d -1-tte - iZt
Is your property within 200'of the following: Body of Water(Name) Saltwater
Lake River/Creek Pond Wetland Seasonal Runoff Stream
Slopes or Bluffs
TYPE OF JOB New Add Alt Repair Other Use of Building
Location of Fixtures/Units 1st Floor 2nd Floor Basement Garage Closet
PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Fuel Type: Electric
Type of Fixture No.of Fixtures Fees LPG Natural Gas Heatpump
Toilets Type of Unit No.of Units Fees
Bathroom Sink Furnace
Bath Tubs Heatpumps
Showers Spot Vent Fan
Water Heater Propane Tank
Clothes Washer Gas Outlets A ^
Kitchen Sinks Wood/Gas/Pellet Stove
Dishwasher Kitchen Exhaust Hood
Hosebibs Dryer Vent
���
Other Other a;
Base Fee Base Fee 2b
TOTAL PLUMBING TOTAL MECHANICAL
A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF FIXTURE/UNIT.
NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF
CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the
information provided is accurate and grants employees of Mason County access to the above described property and structures for review and
inspection of this project. Acknowledgment of such is by signature below:
OWNER A IDAVIT-I certify that 1 am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a
Contractor egistration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washington and that I am aware of the ordinance
requirem is for which 4Epermit is issued and that all work will be done in requirements regulating the work for which this permit is issued and all work
co ith. N es shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without
approv first obtaining approval.
&A 7
X Date X Date
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by Date Submittal Amount Due Receipt No.
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:::::::<.:::>::>:::... >:>:dS AR1MEtVi'AL:IKl1 51# :::>::>:>:: »:>::a:>::::>::>:::::RF R
Building Department — E/I7L=7kR l VtYMAI
Occ Group Type Constr. — 2W Z—e0o .�
Planning Department
/ RFSOLUFO
Other
Other
.............:::::::.::::::.:::.::............................:.:.:......................................................................................................................................
Permit Fee Site Inspection
Plan Review Fee UFC Plan Review Fee
Plumbing&Base Fee Other
Mechanical&Base Fee Other
Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal ( )
Violation Fee TOTAL FEES