HomeMy WebLinkAboutBLD2008-00208 - BLD Permit / Conditions - 2/25/2008 I
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MANUFACTURED HOME
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FRAMING Floors FIRE DEPARTMENT
Date Ely Da to BY Date By
Walls DECKS
PLUMBING Date Ely Date BY
Groundwork Vault TANKS
Date By Date BY
Date Ely Attio
D.W.V Date By OTHER
Date DRYWALL Type:
Date BY
Waterline Date By Type-.
Date gy Int.fk*;e Wall Date BY 00
Date By F
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MECHANICAL ..............1 -1----- 1 INAL INSPECTION Fire Seperation
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MASON COUNTY PERMIT NO.
_l, ctJ �Q
PLUMBING/MECHANICAL PER IT APPLICATION ;
426 W. Cedar• P.O. Box 186, Shelto WA 98584
Sh ,ton (360) 427-9670• Belfair(360) 275-446 • Elma (360) 482-5269
On the web www.co.mason. us
APPLICANT INFORMATION CONTRA TOR INF�,RRTTIO
Owner ` - — `` Company am 'r
Mailing Address— Mailing A ress
City State A, Zip Code CityState Zip Code
Phone Other Ph. Phone Other Ph.
Lien/Title Holder Contracto Reg. 4 Exp.
E mail address E Mail Ad ress
Drivers Lic.# µm DOB Drivers Li. # DOB
SEPTIC INFORMATION - Connect to New Septic Existing S ptic Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No. Fire District
Legal Description
Site Address (Please include treet name, street number and city)
Directions to site ; 1-il -1� -, . I? j g,� �'I
x-
Is property within 200'of Saltwater Lake River/Creek Pond
Wetland Seasonal Flunoff Stream Slopes or Bluffs > 15%
TYPE OF JOB - New dd Alt Repair Other _Use of Building
Location of Fixtures/Units - 1 st Floor. 2nd Floor Basement Garage Closet
PLUMBING FIXTURES (Show Number of each) MECHAN CAL UNITS
Type of Fixture No. of Fixtures Fees Fuel Typ lectric— LPG Natural Ga$__ Heat Pump_
Toilets Type of U it No. of Units Fees
Bathroom Sink Furnace
Bath Tubs Heatpum
Showers Spot Vent an
Water Heater Propane nk
Clothes Washer Gas Outlets
Kithen Sinks Wood/Ga;/Pellet Stove
Dishwasher Kitchen Exhaust Hood
Hosebibs Dryer Ver t
Other Other
Base Fee Base Fee _
TOTAL PLUMBING TOTAL MECHANICAL
C MVER/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 t 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 th permission from all the necessary parties.If permission is
required from any easement holder or any other party in interest regarding this applicatior 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 accurate and grants employees of Mason County access to the above descr't d property and structure for review and inspection.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECT,
X Date:
Owner/Owners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND HIS 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 Ins ction
Mechanical & Base fee UFC Pla `Review Fee
Wood/Gas/Pellet Stove Fee Other
Violation Fee TOTAL ES