HomeMy WebLinkAboutCOM2005-00058 Final Change in Tenant MIS99-0231 Final Tank and Pump - COM Permit / Conditions - 5/4/1999 o
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c Date By Gas Piping Date By
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Foatings I setbacks Floors FI NAL I NSPECTION
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Date By Date By Date By
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Date By WALLBOARD NAILING
Date By
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Dote By
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Data B 08Qe i; 2 o2r By Izv Dale By
Type of insp. Pass/Fall Request Date inspect.Date Done By Comments
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PERMIT N MIS
MASON COUNTY
MISCELLANEOUS PERMIT APPLICATION
426 W.Cedar/P.O.Box 186,Shelton,WA 98584
Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 2-5269 Seattle 206 64-6968
APPLICfiNT INFORMATION CONTRACTOR INFORMATION
Owner(Iazuxrre e: Contractor Name
Mailing Address 9 jr_q t Mailing Address
City rQ:d State_ Zip Code 485zg, City State Zip Code
Phone(36o )Z-7,c_ yZ-y-etherPh.( I Ph.( Other Ph.(
Lien/Title Holder. -lEm:' i LAuan t�.,lc�2 . Contractor Reg. #
Address SA it,f.- Expiration
PARCLL INFORMATION-12 digit Tax Parcel No. 12392 / 50 _/ ann rp 3 Fire District_F:7—
Legal Description ems, A"3 j?, �r S Z(o �, r�z. :>
Site Address(include street name and city Z Z Li:Q:,Z i k_w ,'8SZ8
Directions to site:
Will timber be cut and sold in parcel preparation? (Yes/No) �AQ
Is your property within 200' of the following: Body of Water(Name) Saltwater
Lake M River/Creek Pond Wetland Seasonal Runoff Stream Slopes or
Bluffs
TYPE OF JOB New Add Alt Repair Other Use of Building —
Describe proposed construction l-W Lar 5� �'�-���-rrc��c rimy — E--o+J ►,)(,�b cam,
Yee Y, oo6 L C.0
SHORELINE PROJECTS New Replacement Repair Expansion
Bulkhead Material (concrete, rock, wood, etc.) Length Height
i
A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF PERMIT.
E.
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 AFFI6AVIT-1 certify that I am exempt from the requirements of CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a
the Contractor Registration Law RCW 18.27 and am aware of the 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 ordinance requirements regulating the work for which this '-
q P q " g g permit is is�ed
will be
done in conformance therewith. No changes shall be made without and all work shall be done in conformance therewith. No changes shall
first obtaining approval. be made without first obtaining approval.
X Date X Date
FOR OFFICIAL USE BEYOND THIS POINT
i
f 3
Accepted by Date Submittal Amount Due Receipt No.
DEPARTMENTAL REVIEW APPROVED DENIED CONDITION CODES
Building Department
Occ Grp Type of Const.
Planning Department i
Environmental Health Department
f �
Public Works Department
f Fire Marshal
Valuation$ i
>` FEES
is Building Permit Fee Site Inspection
f Plan Review Fee Other
UFC Plan Review Fee Other
Violation Fee Pre-Paid at Submittal ( )
TOTAL FEES -
v
FORM MUST BE COMPLETE .N NK`
PLEXSE PRESS HARD 0.1 PERMIT NO.: MIS vc
MASON COUNTY
MISCELLANEOUS PERMIT APPLICATION It 4 Z
426 W.Cedar/P.O.Box 186,Shelton,WA 98584
'91 Shelton 360 427-9670 Belfair 360 2754467 Elm. 360 82-6269 Seattle 206 64-6968
APPLIC�NT INFORMATION CONTRACTOR INFORMATION
Owner ,t; ���c�,a�•..,,5 Cza< Contractor Name
Mailing Address 1r,I, _N_,4_-1 Mailing Address
City ,-<<.,� State\,,,j., Zip Code -je;szF: City State Zip Code
Phone( ) ?-7.5_ uZ ether Ph.( Ph.( Other Ph.( �
Lien/Title Holder .5 :- f > .��,� �t� ,z . Contractor Reg. #
Address S1.1,,4,�a Expiration
PARCEL INFORMATION-12 digit Tax Parcel No. _ 1,2 3 Z / ��i� / , �b Fire District
Legal Description_-'t' s. A 1 i4,• e�4-
Site Address(include street name and city "�2[.. �,.<<_�•; 3 „�i , _.> i t_ i� r ,��
Directions to site:
Will timber be cut and sold in parcel preparation? (Yes/No) &Ao
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 -
Describe proposed construction K4C - EX i-�,Aj �c�
Y2v� c 0 0 e- ; r
SHORELINE PROJECTS New Replai;ement Repair Expansion
Bulkhead Material (concrete, rock, wood, etc.) Length Height
A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF PERMIT.
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 DAYSAT,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-I certify that I am exempt from the requirements of CONTRACTOR'S AFFID4VkT-1 certify that I am currently registered as a
the Contractor Registration Law RCW 18.27 and am aware of the contractor in the State of Washiogton and that I am aware of the
ordinance requirements for which this permit is issued and that all work ordinance requirements regulating the-work for which this permit is issued
will be done in conformance therewith. No changes shall be made without and all work shall be done in conformance therewith. No changes shall
;a first obtaining approval. be made without first obtaining approval
X Date X Date
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by Date Submittal Amount Due Receipt No.
DEPARTMENTAL REVIEW APPROVED DENIED CONDITION CODES
Building Department
Occ Grp Type of Const.
Planning Department
r
Environmental Health Department
Public Works Department
Fire Marshal
Valuation$
FEES
Building Permit Fee Site Inspection
Plan Review Fee Other wage,ur
UFC Plan Review Fee Other
Violation Fee Pre-Paid at Submittal ( )
TOTAL FEES
qq
31
I PERMIT NO.:
MASON COUNTY
5-i
PLUMBING/MECHANICAL PERMIT APPLICATION
426 W.Cedar/P.O.Box 186,Shelton,WA 98584
Shelton 360 427-9670 B 6T Elma 360 482-5269 Seattle 206 464-6968
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner�_tw^i-_ ► ,-11ziE„s=t-is 1; < Contractor Name
Mailing Address_fl?O. Bat 2a6 i I Mailing Address , ii
City_ ,ffi & State s Zip Code`3852.16 City State Zip Code
: Phone('40 )275•A42?1 Other Ph.( Ph.( Other Ph.( )
Lien/Title Holderje-ter A LAU" &AkZJX,. Contractor Reg.#
Address SArh2 Expiration / /
RwTIC INFORMA ION-Connect to New Septic Existing Septic Connect to Sewer System Name of
er System
PARCEL INFORMATION-12 digit Tax Parcel No. 17 3ZZ /,qb _C%CNC]G:3 Fire District_
Legal Description:Ms' • A,s 8 cF S "moo oF' -tR. 7
Site Address(Please include street name, street number and city) 2.Zb`T 1 guja c 3 tZE35:Q-1, ^ ► S R
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
nLoca:�tion
OF JOB New Add Alt Repair Other Use of B ding of Fixtures/Units 1st Floor Alt.
Floor Basement Garage Closet
PLUMBING FIXTURES(Show Number of each) MECHAN.CAL UNITS Fuel Type: Electric
Type of Fixture No. of Fixtures Fees LPG ,/ Natural Gas Heatpump
Toilets Type of Unit No. of Units Fees
Bath Basins Furnace
Bath Tubs Heatpumps
Showers Vent Fans
Water Heater Propane Tank �.50
Laundry Wsher Gas Outlets �•SQ
Sinks Wood/Gas/Pellet Stove
Dishwasher Direct Vent?
Other Other
Other Other
Base Fee Base Fee -L 2
TOTAL PLUMBING TOTAL MECHANICA
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-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT4 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
approval. first obtaining approval
X Date X Date
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by V`1 Date_ I'-!t _Submittal Amount Due S� Receipt No.
...........................................................:::: '(.::. :........ ........... '--.............. .-..................... ... .................
£li .IIRFM�#. :.;::-:;:;;:.:::.:.;:;;;:-.::.
Building Department V 12-"
Occ GroupLA,%k Type Constr.
Planning Department
Other
Other
Permit Fee Site Inspection
Plan Review Fee UFC Plan Review Fee
Plumbing&Base Fee Other f
Mechanical&Base Fee Other
r'
Wood/Gas/Pellet Stove Fee Pre-Paid atsubhOal ( 7 )
Violation Fee TOT E S `
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