HomeMy WebLinkAboutMIS92-0148 Final Pellet Stove - MIS Application - 12/11/1992 �u�L�uv� rr,.rc.lvll i tit'rL1l:A 1 lUl�I
PLEASE PRINT
# Owner ` '�t� �-g>✓ o ,�� Phone# /S= 0,5/SS—
Site Address��a p1.4W.- J,-, (:J ('t
City �.� ; rr- ySt i.� � Zip__ ���� �
Dire ions to Job Site 4h` Alo r?1 ��a�,� -/. S
t
Owner Mailing Address 0 �X
City_. ..� � 1 ��.:� �
St— Zip 2LS—�1 Lien/Title Holder ®
Address
City St
Zip
#2 Contractor Name Contractor Reg#
Address Expiration date_
City St Zip Phone
#3 If septic is located on project site, include records.
Connect to Septic?__ Public Water Supply Well
(If residential, proof of potable water may be required)
C4) Parcel No. 9 p d 7
Legal Descri.pti n - o ' car
#5 Building Square Footage: (existing/proposed)
1st Fl_ / 2nd Fl_ / 3rd Fl / Loft /
Basement /__ Deck ' / #bedrooms
.(_ #bathrooms____ __
Garage / Carport- / (Circle: Attached or Detached?)
Other sq f t /
#6 Us f ui din k.0 Describe work2
#7 Type. of Job: New, Ad Alt_ Repair
Woodstove p Demolition
______ Re Roof_ Bulkhead_ Other
#8 MOBILE I;nmr TNFORMAT'rON
Model Year Make Model
Length Width Serial No.
#Bedrooms_____ #Bathrooms Type of Heat
#9 Any water on or adjacent to property: saltwater
lake
river
pond wetland seasonal runoff______
other
Lot Dimensions Flood Zones
Existing Structures Fences
Structure Setbacks Driveways
Water Lines Shorelines
Drainage Plan Topography
Septic 'Systems Wells
Proposed Improvements Easements
Name of Flanking street Scale:
Name of Fronting Street Date:
APPLICANT TO DRAW SITE PLAN BELO
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELO
. j
j
1
No. Toilets poA
Bath Basins Vent Systems X :3 . 00
Bath Tubs Vent Fans X 3 . 00
Showers No. Boilers/Compressors
Hot Water Htr 0-3 Hp _
Laundry Washer 3-15 Hp
Sinks 15-30 HP �
oor Drains 30-50 Hp
La ry Basins 50 + Hp
. Air --6.2Q-
Dishwa er No iag unit
Disposal <= 0000 cfm.
Urinals > 10000 cfm.
Other Other
Evap Coolers
Permit Basic Fee _.Hoods --TOTAL PLIIbg1I2,G $ Fire Suppression
Domes. Incin.
Mech Fitr Coanl• Incin.
anicalReloc/Repair
No. Fuel Types Gas Outlets X 2.00
—Furn < 10 BTU odstove se arat
—Furn > 100K BTU �� Oth
FU - Floor
---6-.U-
eat Pump �' Permit Basic _
s 0
TOTAL MCHANI $
F
: THIS PERMIT BECOMESIZED IS NOT COI�NCED NIILL AND VOID IF WORK OR CONSTRUCTION
ENDED OR WITH 180DAYS, ORIFCONSTRUCTION OR WORKENCED ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER WORK
OWNERS AFFIDAVIT
FTHE
ORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE
CONTRACTORS REGISTRATION LAW RCW 18.27 , AND AM AWARE HAT I AM A CURRENLAUARE
ED CONTRACTOR
OF THE MASON COUNTY ORDINANCE REQUIREMENTS FOR WHICH TE OF WASHINGTONAWARE OF THE
THIS PERMIT IS ISSUED AND THAT ALL WORK DOME WILL BE IN ORDINANCE REQUIREMENTS REGULORK FOR WHICH
CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE THE PERMIT IS ISSUED AND ALE WILL BE IN
WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING CONFORMANCE THEREWITH. NOHALL BE MADEEPARTMENT. WITHOUT FIRST OBTAINING APPTHE BUILDING DEPARTMENT.
X OWNER
DATE a BY
DATE
Return permit to: Department of General Services
426 W. Cedar/p.O. Box 186, Shelton, WA 98584 427-9670 - _ _
/1 800 562 5628
FOR OFFICIAL USE ONLY: Accepted by:
Date:
Approved Cond Hold
Approval
i
Planning: }
,l
1
Environmental Health:
Building Plan Review:
Occupancy Group:
Fire Marshall:
Other:
FEES
11Special Conditions: 11 {(Site Inspection ( ((
II 11 l'
II 11 I1Bui.lding Permit ( it
11 11 I
II 11 Ilviolation Fee J ({
II 11
II 11 11violation Investigation Fee I II
11 11 H �1
II 11 IlPlan Check I II
lI II 1i i 'I
II 11 I1 Plumbing Fee I II
11 11 1
II 11 IlMechanical Fee I
11 II i
II II ilWoodstove Fee
it 11 1` '
II 11 IlBuilding State Fee I q
IlBuilding valuation: I1 1i TOTALI �
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m
00
O 0
0 � 0
01 � z
0 - 0
� Q
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Q N z
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100
C �
0
I
CONCRETE MECHANICAL MOBILE HOME
Footings-Setback date by Ribbons
date by Gas Piping date Set
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 OTHER
Attic
Groundwork date by
date by WALLBOARD NAILING
D.W.V. date by
date by Water Line FINAL.INSPECTION
date by date _11 � b date by