HomeMy WebLinkAboutMIS99-0650 - MIS Permit / Conditions - 1/10/1999 sp
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CONCRETE
Footings-Setback MECHANICAL MOBILE HOME
date by date by Ribbons
Foundation Walls Gas Piping date
date b date by Set U
y INSULATION p
BG/SL-AB Insulation date by
date Floors c: -
by i. anal
FRAMING date by date by
date by Walls FIRE DEPT.
PLUMBING date by date by
Groundwork Attic OTHER
date by I date by
D.W.V. i WALLBOARD NAILING I
date by date by
Water Line FINAL INSPECTION
date by date
by
date —!
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PERMI .:
FORM MUST BE COMPLETED IN�NK
PLEASE PRESS HARD MASON COUNTY
PLUMBING/MECHANICAL PER IT APPLICATION
426 W.Cedar/P.O.Box 186,Shelton,IVA 98584
Shelton 360 427-9670 Belfair 360 275.4467 Elma 360 4 2-5269 Seattle 206 464-6968
APPLI T INFORMIAT ON, CONTRACTOR IN-FORMATION
Owner Contractor Name yl Cc o
Mailing Address 1 E W41gH 7 DR- Mailing Ad ress
City State Zip Code <S S' City State Zip Code
Phone =~ they Ph.(� Ph. Other Ph.(_�
Lien/Title Holder Contracto Reg. #
Address Expiration
SEPTIC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of
Sewer System
PARCEL INFORMATION_A igit Tax Parcel No. 44 CJ/ &?, Fire District
Legal Description C)O
Site Address(Please include street name, street number and city)
Directions to site w -1- Al
Is your property within 200' of the following: Body of Water(Name) Saltwater
Lake River/Creek Pond Wetland Seasonal F unoff 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) MECH OLNICAL 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 Heatpl.mpS
Showers Vent Fans
Water Heater Propar e Tank l
Laundry Wsher Gas Outlets
Sinks Woo as ellet Stove
Dishwasher Dire ent?
Other Other'
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/UN T.
NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUT ORIZED 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 tot ie 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 CONTRAC OR'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 requirement regulating the work for which this permit is issued and all work
conformance therewith. No changes shall be made without first obtaining shall be dont in conformance therewith. No changes shall be made without
appr first obtainin approval.
'1, r
X Date X Date
FOR ICI USE BEYONC THIS POII)l,T
Accepted by Date Submittal Amount Due C,r'� Receipt No.
r/
t)kFRRTMEtdTA(;RE liE1N Af'PROVEQ<:: R>^NIE{3?: <:' ::;:: cr °GONRITIQN.....
Building Department
Occ Group Type Constr.
Planning Department
Other
Other
IF
.....................................
Permit Fee Site Inspection
Plan Review Fee UFC Plan Re)7 Fee
Plumbing&Base Fee Other
Mechanical&Base Fee Other
Wood/Gas/Pellet Stove Fee Pre-Paid at Subm ttal ( )
Violation Fee TOTAL FEES