HomeMy WebLinkAboutBLD2011-00368 relocate bathroom - BLD Permit / Conditions - 5/25/2011 W 1
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o CONCRETE MECHANICAL MANUFACTURED HOME ,
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Footings /Setbacks Date '�ilr'l�� By C.__ Ribbons Z
Gas Piplh
o Interior Date y Interior-Date By Date By N
rn Exter Date y Exterior-Date B Set-up
°° INSULATION
Point Load#Isolated Footin Date By F
Date y Date SLAB INSULATION By FIRE DEPARTMENT .._ .. _... D
Foundation Walls Floors bats By
Date By Data By DECKS
FRAMING Walls Date By
Date BY Data By PROPANE TANK
PLUMBING Vault Date B y�
Date By OTHER
Groundwork Attie
Type-
Date lay Date ByDate By
D.W.V DRYWALL Type
Int Brace Wall gate By W
Date Y Date BY FINAL INSPECTION 0
En Water LineFire Separation f ►v
Date y Late By Gate 7 I ! ByCD
o Pass Or Request Inspect. o
Type of Insp. Fai Date Date Done By Comments w
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PERMIT NO. t Id ZG 11— &+30
MASON COUNTY
PLUMBING/MECHANICAL PERMI APPLICATION
426 W.Cedar- P.O.Box 186, Shelton,W 98584
Shelton (360) 427-9670-Belfair(360) 275-4467-E ma(360)482-5269
On the web www.co.mason.wa.0
APPLICANT INFORMATION CONTRACT INFORMAT ON @ �r
Owner h/t I I&t r-o, 0 L/ Company Na e
Mailin Add s W ° 4°`"�` Mailing dre s C'�
City �- �'`^ tate�Zip Code City Ota�w O Zip Code
Phone Other Ph. Phone
Lien/Title Holder Contractor Re Exp R
E Mail Addres `�.
E mail address t
Drivers Lic.# DOB Drivers Lic.# 03 DOB
SEPTIC INFORMATION - Connect to New Septic Existing Septi Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION- 12 Digit Parcel No. 42n 1 ' - = I Fire District
Legal Description
Site Address (Please include street name, street number and city)
Directions to site
Is prope y within 200'of Saltwate Lake k 1,4eRiver/Cr ek Pond —
Wetland Seasonal Runo Stream Slopes or Blu s 5 15%
TYPE OF JOB - New Add Alt Repair Other se of Building
Location of Fixtures/Units- 1 st Floor '-'#<i_ 2nd Floor Basement Garage—Closet—
PLUMBING FIXTURES(Show Number of each) MECHANIC IL UNITS
Type of Fixture No. of Fixtures Fees Fuel Type:Ele rim_ LPC Natural Gas_ Heat Pump_
Toilets _ Type of Unit No. of Units Fees
Bathroom Sink t Fumace
Bath Tubs Heatpumps
Showers 1 Spot Vent Fa
Water Heater f Propane Tan
Clothes Washer Gas Outlets
Kithen Sinks Wood/Gas/Pe let Stove
Dishwasher Kitchen Exhau st Hood
Hosebibs Dryer Vent
Other Other
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 c ntractor.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 per mission from all the necessary parties.If permission is
required from any easement holder or any other party in interest regarding this application or tie work proposed in the application,I have obtained
permission from them to apply for this permit and conduct the work proposed. The owner or alent on owners behalf,represents that the information
provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection.
PROOF C�IV�TlNUATIJN OIL VI(ORB PROGRESS INSPEC N. 1 w
/` t
X Dat
�- _
Owner/Owners Representative' Contracto K (indicate which one)
FOR OFFICIAL USE BEYOND TH13 POINT
Accepted by: Planning Pd Ck# Date Bld Pd Receipt No.
DEPARTMENTAL 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 FEE
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L
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RECEIV D
MAY 0 9 201
426 W. CEDAR ST.
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FILE13UILD �,►�a
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