HomeMy WebLinkAboutBLD2003-00339 - BLD Permit / Conditions - 3/28/2003 �
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FORM MIST BE COMPLETED IN INK PERMIT NO.:
PLEASE PRESS HARD MASON COUNTY
PLUMBING/MECHANICAL PERMIT APPLICATION
426 W.Cedar/P.O.Box 186,Shelton,WA 98584
Shelton 360 427-9670 Belfair 360 276.4467 Elma 360 482-5269 Seattle 206 464-6968
APPLICA "FORMATION " CONTRACTOR INFO TION
Owner L Contractor Name �
Maili Address Mailing Address
City State LLY.& -.Zl Code �. _ � City State Zip Code
Phone Other Ph.( Other Ph.(�
Lien/Title Holder Contractor Reg. #
Address Expiration
SEPTIC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of
Sewer System
PARCEL INFORMATION- 12 di it Tax Parc o. / / ( ( ` `( Fire District
Legal Description L
Site Address(Please include street nam ,street number and ci Y
Directions to sit 4' C 6
7 '
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 pe: Electric
Type of Fixture No.of Fixtures Fees LPG Natural Gas Heatpump
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
Kitchen Sinks Wood/Gas/Pellet Stove
Dishwasher Kitchen Exhaust Hood
Hosebibs Dryer Vent
Other Other
Base Fee �� Base Fee
TOTAL PLUMBING a 7- t-) _ 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
co ante therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without
approv first obtaining approval.
17
Datg - X Date
FOR OFFICIAL,.. USE BEYOND THIS POINT
z-
b /�
Accepted �p y �_ '- Dater �S�Ibmittal Amount Due Receipt No. -
:AEPARTMENTAt f� Vil APPROV:D. CfEN1ED GONDITIfJN Ct�:l3ES
Building De nt O
Occ Grou T e Constr. /
Planning Department
Other
Other
)I.:ES.
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
d `
Building Permit # a-3 MASON COUNTY
BUILDING 111 426 W. CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRECTION NOTICE
Job Location `7
This structure has been inspected by Mason County Building Department
and the following VIOLATION of County Laws and Ordinances has been
found: Items Listed below must be corrected to gain code compliance
`-'yr5t;c.�lTE EfL l_ Lr i t-z)A t i'IsU44'1�v,a✓
>
" ✓Q �d vH ,� 'i
You are hereby notified that the above corrections shall be made
BEFORE PROCEEDING WITH ANY FURTHER WORK
Call for re-inspection when corrections are made before continuing
❑ Make corrections, items will be checked on next inspection
❑ OK to
❑ This is not a complete inspection �Li /�✓j,,
Department
Date 1Y1 7 L,� Inspector
DO IDIOT REMOVE THIS TAG
r
o CONCRETE MECHANICAL MANUFACTURED HOME'
o Footings I Setbacks Date By Ribbons
o Date By Gas Piping Date By
W Foundation Walls Date B y Set-up
Date By INSULATION Date By
B G 1 Slab Insulation Floors Final
Date By Date By Date By
FRAMING Walls FIRE DEPT
Date By Date By Date By
PLUMBING Attic OTHER
Groundwork Date By
Date By WALLBOARD NAILING
D.W.V. Date By
Date By FINAL INS:PECTIQ.N
Water Line Date 'e
t-=
Date // By Date By
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