HomeMy WebLinkAboutCOM2001-00145 Fuel Tank - COM Permit / Conditions - 11/21/2001 C)
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MECHANICAL MOBILE HOME
Foodng3.Sed)ack date PJ.)bon3 by
date
date g Set Up
Fax�dadon Watt date
INSULATION Final
date
EICVSLAI3 Msulauw Floors
date
date by date by FIRE DEPT.
FRAMING Wans date by
date by date by OTHER
PLUMBING Attic
Groundwork date by
to by WALLBOARD NAILING
D.W.V. date by
to by FINAL INSPEgnON
Water Line date by date by date by 1
AYr < /vc) l�z� p . ph .:r w��c 1`�istrLr4Ti�u I ��J
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PERMIT NOZ0114 "—"l6DI q!�
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 INFOWA. J.ON
Owners �;�4, t R°r�r� iW tF,�_; �r"' . Contractor Name '"`
Mailing Address�-, Mailing Address
City,` ,fE State r" Zip Code City State Zip Code
Phone( Other Ph.( Other Ph.(
Lien/Title Holder Contractor Reg. #
Address Expiration
SEPTIC INFORMA'RON- nn t to eptic Existing Septic Connect to Sewer System Name of
Sewer System `*
PARCEL INFORMAT,IQN-12 di 9it Tax Parcel No. ` `: '�'- / f° / '' %'i';., Fire District '
,- �,.�
Legal Description
Site Address(Please include street name, street number and city)
Directions to site y"v"v;t
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
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 %`rt,,V
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 AFFIDAVIT-I 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 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
Date :'� .�-`i� �s�
FOR OFFICIA4 USE BEYOND THIS POINT I ,
Accepted by e Date t 7 �ubmittal Amount Due Rec40 i del <"-
Qk A. TALI#i.. E R V£D;:.'D1 NIE#3: ...:,:.:: +GQNDFfIQht F3E5
Building Departm t o rd" ai/ i� i 'L �(i r C r� ::fi 2 T Ut, ' tl C3
Occ Group a Constf. l v; 0-E 3, . r�{1'r�" i 1
Planning Department
Other
Other
:::.:::::::::..:...:.:..: . ..:.
I t"E ............... ...
.........................................:...•.....................................................................................................................................
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
FORM
LEASEPMUST
PRESS HARD COUNTY PROJECT SITE INFORMATION
N INK
PLEASE PRESS HARD
Case No.
L IrA—PARCEL NUMBER Date
SHOW THE FOLLOWING ON SITE PLAN Show Direction by indicationg N, S, E, W in relation to the
site plan
Lot Dimensions Fences
Existing Structures Driveways
Structure Setbacks Shorelines
Water Lines Topography
Well Location (including adjacent) Drainage Plan
Names of Streets
Easements
Names of Fronting Streets Septic System
DRAW SITE PLAN BELOW Include adjacent ro erties if on shoreline or within 100 feet of adjacent property line.
�� I E-adjacent property line
adjacent property line4
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SAMPLE SITE PLAN
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TOPOGRAPHY PROFILE(Show a side view of property. Show slopes, cuts and fills. If possible include height and the
degree of slopes. See sample topography profile.)
SAMPLE TOPOGRAPHY PROFILE
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MASON COUNTY PROJECT SITE INFORMATION
Case No.
r
i, �/ - PARCEL NUMBER� 1 '''�%�a` e1O1�5 Date
Name,`' t P� l�� * f.t , —�--
SHOW THE FOLLOWING ON SITE PLAN Show Direction by indicationg N, S, E, W in relation to the
site plan
Lot Dimensions Fences
Existing Structures Driveways
Structure Setbacks Shorelines
Water Lines Topography
Well Location (including adjacent) Drainage Plan
Names of Streets Easements
Names of Fronting Streets Septic System
DRAW SITE PLAN BELOW Include adjacent properties if on shoreline or within 100 feet of adjacent property line.
adjacent property lined M_..___. ______.__. ___._...._.__ __.___....I F-adjacent property line
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adjacent ro ert line- I I E-adjacent property line
SAMPLE SITE PLAN
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adjacent property I ined a". \i E-adjacentproperty line
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degree of slopes. See sample topography profile.)
SAMPLE TOPOGRAPHY PROFILE
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