HomeMy WebLinkAboutBLD2002-00300 Final Propane and Outlets - BLD Permit / Conditions - 5/17/2002 cu
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CONCRETE
Footings-Setback MECHANICAL MOBILE HOME
datedate by Ribbons '
;by Gas Piping date
Foundation Walls date 3-2 7'ZD0 Z b / b r
date y Set Up
BG/SLAB Insulation INSULATION date by
date by Floors Final
FRAMING date by date b
Y
date by FA
FIRE DEPT.
PLUMBING by date by
Groundwork OTHER
date b by
D.W.V. WALLBOARD NAILING
date by date b
Y
Water Line FINAL INSPECTION
date by date _ �Z by -�
date by
-------------
io G�fsz,,,.E
T� A7- �i/ls TiM��
_. r
FORM MUST BE COMPLETED IN INK PERMIT NO.:M-n 2.cQac)
PLEASE 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 itQi�it40ez-& L. /,/C/✓�' JUG✓ Contractor Name
J Mailing Address �o/�dX s9� Mailing Address
T City�ILL,�A✓ Statew.Io Zip Code z City State Zip Code
PhoneC{do )27s4s-C Other Ph. -a 2 Ph.( Other Ph.(
Lien/Title Holder Znn •, -7&/ Contractor Reg. #
AddressS 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 / / OA Fire District-.S"
Legal Description
Site Address(Please include street name, street number and city)/C.5S0 f7 e ,,
Directions to site
Is your property within 200' of the following: Body of Water(Name) Saltwater
Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or
Bluffs
,4 TYPE OF JOB NewA Add Alt Repair Other Use of Building
Location of Fixtures/Units 1st FloOLX 2nd Floor Basement • Garaged_Closet
PLUMBING FIXTURES(Show Number of each) MECHyNICAL UNITS Fuel Type: Electric
Type of Fixture No. of Fixtures Fees LPG x Natural Gas Heatpump
Toilets Type of Unit No. of Units Fees
Bath Basins Furnace
Bath Tubs Heatpumps
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
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 AFFIDAVIT4 certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-1 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►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
approval. first obtaining approval.
Z��_X Date_ . Z X Date
FOR OFFICIAL USE BEYOND THIS POINT
Accepted b Date 2Y-9X, Submittal Amount Due '4A Receipt No. t L1O O
:.;:.;:.;:.;;:.:.:.;:.;: . ... .... .. [i......�luik#............................................... htC�'I .G4:Cit±s:::::::::::::::::.::.::::::::: :.;;:.>;.;:.;:.:
Building Department
Occ Group Type Constr.
Planning Department
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