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(D CD in v CD -0 Q (D xm (Dsv �isn � O a 0 -i O �w3 m (n (n CD ° 3 c � O a � cn LIDO (n � ° o CCD m0 CDcn zr CD N o (D m CD a O o Q So � oQ = m 5o 0o m n cn (D o a D � o 3 o, a m 3 3 (D. � C K r Q o O m 0 � CD0 CDw � (D � w (c =) a ° o o `< a CD o m � gO Q CD ac_• o o CD o o � __ Dcr-0 CD O � oc = (D N a C1 Q O C1 C m Z cn v O m c0 G r. zr _0 - Q `G m en flrt.) L°S o N N O y N (D — S N CD Qj CD n O N .+ Cv CD z 0 c N (D '� fll C O Z CD N (D Permit number BLD Mechanical Permit Checklist • Name of owner: • Fuel Type? LPG Nat Gas Electric Other • If propane, what is the proposed size of tank(s)? • What type of mechanical unit will be installed? (i.e.freestanding stove,forced air furnace, etc.) e0A i f mLy-w-t • If the unit is a wood stove,provide: Make Model Year Label Number • What is the use of the structure? (Circle one) esiden al Commercial (A permit application for a commercial mechanical permit e upon satisfactory review by staff. Include a floor plan showing the location of units)and layout of duct work with the permit application.) • Type of structure: (Circle one) rte BB H m Manufactured Home Other • What room will the mechanical unit be located? • Will the unit be located in a basement? (circle one) Yes No • How will combustion air be supplied to the mechanical unit? (Describe, i.e. direct vent, air inlets, etc.) • How will the mechanical unit be exhaust e to the outside? Applies to appliances using gas, oil or wood fuel. (Indicate B-vent, direct vent, L-vent,etc.) • What year was the structure constructed? Was this structure part of a PUD upgrade? • What type of controls will be installed? (i.e. thermostat, etc.) Z-`Xt'5t i,iLp • Will the proposed mechanical unit be a heat source?(circle one) No • Additional information: Signature of Applicant -- Date Typical mechanical fees: Forced air furnace $ 18.30 Heat pump 18.20 Propane tank 73.00 Gas Outlets 6.20 additional outlets over 5, $1.15 each Mechanical base fee 28.50 or $ 9.00 if base fee was paid on an active building or mechanical permit Freestanding unit, fireplace, pellet stove or wood stove $73.00 $4.50 state fee will not be collected on mechanical permits o CONCRETE � �i�'i"� MANUFACTURED HOME > No — Intarior-D By �� Z N Footings l Setbacks Fzter gate Ribbons Z m C) Date By INSULATION! Date By G' Found-ation Walls Set-up � 8Cs t SLAS IN JLATIUN 0 Late 8y Date By late By Q FRAMING Floors FIRE DEPARTMENT Date By Date BY Date B� 1Nalls PLUMBING Date By DECKS 1>9 tB BY Groundwork Vault TANKS Date By Date By Date By Attic D.W.V Date By OTHER Date By DRYWALL Type: Date Water Line Date BY Type: W Date By Int.Brame Wall Date Byate BY r— CD MECHANICAL ®Irg Sepati«a FINAL INSPECTION o m Date By Cate By (Xito BY N N , O Pass car Request inspect.. co oType of Insp. Fail Date Date Done BY Comments 0 Cn o n 0 0 0 0 0 v m 0 MASON COUNTY PERMIT No.�A,260 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 On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR IN OR TIO Owner 'f -F �a't�-� Company Name a el)4"�7 Mailing Addres 3 Mailing Addresses �'X I`!oK City 5J'(L) State W� Zip Code d�� City State Zip Code Phone �`?�- T-2 1_2 Other Ph. Phone ILC `j`+ 6 6 Other Ph. Lien/Title Holder Contractor Reg. # � � /(22 �, Exp. !/- l!-I--3 f�� F E mail address E Mail Address f ' � Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC INFORMATION - Connect to New Septic Existing Septic., Connect to Sewer System Name of Sewer System PARCEL INFORMATION- 12 Digit Parcel No Fire District Legal Description Site Address(Please include street name, street number and city) Directions to site Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% 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 Type of Fixture No. of Fixtures Fees Fuel Type:Electri4_LPG_Natural Gas_Heat Pump_ Toilets Type of Unit No.of Units Fees Bathroom Sink Furnace Bath Tubs Heatpumps Showers Spot Vent Fan Water Heater Propane Tank Clothes Washer Gas Outlets Kithen Sinks Wood/Gas/Pellet Stove Dishwasher Kitchen Exhaust Hood Hosebibs Dryer Vent Other Other &J.W_ '— Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that I am entitled to receive this permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary parties.If permission is required from any easement holder or any other party in interest regarding this application or the work proposed in the application,I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information provided is a rat d grants employees of Mason County access to the above described property and structure for review and inspection. PROOF OF UATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. X Date: Owner/Owners Representative/ ontractor (indicate which one) FOR OFFICIAL USE BEY I POINT Accepted b A'Manning Pd Ck# Date�'�' J I1Ad Pd Receipt No. DEPARTM NTAL REVIEW APPROVED DENIED NOTES Building Department Occ Group-Type Constr. Planning Department Environmental Health Department FEES Plumbing& Base Fee Site Inspection Mechanical & Base fee UFC Plan Review Fee Wood/Gas/Pellet Stove Fee Other Violation Fee TOTAL FEES