HomeMy WebLinkAboutBLD2000-00086 Final Heat Pump - BLD Permit / Conditions - 4/12/2000 FORM MUST BE COMPLETED IN INK PERMIT NO.:
P,1.EASE PRESS HARD MASON COUNTY
PLUMBING/MECHANICAL PERMIT APPLICATION
426 W.Cedar/P.O.Box 186,Shelton,WA 98584
Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner ��a ni L� e AU Contractor Name
Mailing Address PQ 4, Mailing Address
City F}CLL! IA State&2& Zip Code � City State Zip Code
Phone(.3 )�7Sa&a0 Other Ph.(Y;?& 4190 Other Ph.(�
Lien/Title Holder Contractor Reg. #
Address Expiration
SEPTIC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of
Sewer System
PARCEL INFORMATJ,ON-12�9it Tax Parcel . / ! Fire District
Legal Description `f �Address(Please include street name, street number and city)
Directions to site /..�5—/ IZES -:500TW 64= oyr"'
Is your property within 200' of the following: Body of Water(Name) �� Saltwater
Lake 4t) River/Creek jUl) Pond Wetland .tAp Seasonal Runoff e.> Stream r.3Slopes or
Bluffs
TYPE OF JOB New Add Alt Repair Other Use of Building
Location of FixtureslUnits 1 st 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. o_fUnits Fees
Bath Basins Furnace
Bath Tubs Heatpumps �r
Showers Vent Fans
Water Heater Propane Tank
Laundry Wsher Gas Outlets
Sinks Wood/Gas/Pellet Stove
Dishwasher Direct Vent?
Other Other
Other Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL Sc)
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 AFFIDAVIT-[certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a
Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washington and that I am aware of the ordinance
requirements for which this permit is issued and that all work will be done in requirements regulating the work for which this permit is issued and all work
conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without
appr first obtaining approval.
A411Z 2
Date, X Date
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by Date Submittal Amount Due Receipt No.&Ma�
`IIEP1l1zTMEtVTAi€ 1"1/tEyY` ..: :AP�'R(] D:: QEM1EI U GQNDtfIClTV'Ct�133E5
Building Department / O
Occ Group Type Constr. l�
Planning Department 1.
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
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CONCRETE MECHANICAL MOBILE HOME
Footings-Setback date by Ribbons
date by Gas Piping date b
Foundation Walls date by Set Up
date by INSULATION date by
BG/SLAB Insulation Floors Final
date by date by date by
FRAMING Walls FIRE DEPT.
date by date by date by
PLUMBING Attic OTHER
Groundwork date by
date by WALLBOARD NAILING
D.W.V. date by
date by FINAL INSPECTION
Water Line
date by date 2 ---p v by date by
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