HomeMy WebLinkAboutMIS97-0800 Church - MIS Application - 12/9/1997 Permit No! ' ml-0100
MASON COUNTY
PLUMBING/MECHANICAL PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 • 427-9670
PLEASE PRINT
#1 Owner `Q1'JCE_ Of-- Phone# 3bo 275- -IiI76cv
Site Address M ? 1 1 7 1 5 A 14 0 141LL- 120A%Q
city ) 9-L f=Alll Q St W-4 zip 9 S S;28
Directions to Job Site V,20 VV1 6 tLF:A I vQ UV f:S7 Ot4 I+K)q,3a)—
jug t _4_3 6,+r4,0
Owner Mailing Address
City 13 St I.0 Zip y 1�8-'-.-45
Lien/Title Holder
Address
City St Zip
#2 Contractor Name is L VVYh lS 1 1 IBC. Contractor Reg. #
Address Z C 1+1 coExpiration date
City r6 QL-M b(Z To K j_ St__Ql R zip g 3 312 Phone 36/O `3 73- 29�y
#3 Parcel No. Z 3 15 0.06 I 1
Legal Description
#4 Use of building Describe work
#5 Type of Job: New Add Alt Repair
Plumbing Fixtures j$3.35 each) Fee Mechanical Fixtures ($6.75 eat
No. Toilets CIRCLE FUEL TYPE: Gas, Electric,
_Bath Basins Heatpump, Other
Bath Tubs No. Units Fees
Showers \ _ Furn BTU
41-lot Water Htr 3 35 CrPfOPdvle\) _ Heatpumps
_Laundry Washer _ Vent Systems
_Sinks Spot Vent Fans
_Floor Drains No. Boilers/Compressors
_Laundry Basins _ HP
_Dishwasher No. Air Handling Units
_Disposal _ cfm#
Urinals No. Other
_Other Gas Outlets
Permit Basic Fee 16.75
TOTAL PLUMBING cNin—
Trl-T No Basic Fee for Wood, Gas, Pellet Stove
NOTICE: This permit becomes null and void if work or construction authorized is not commenced
within 180 days or if construction or work is suspended or abandoned for a period of 180 days at any
time after work is commenced. Proof of continuation of work is by means of a oroaress inspection.
NOTE: If this permit application includes the placement of a fuel tank, heat pump or other unit to be located
outside of the existing structures, a plot plan MUST be submitted as required below:
Show following on the site plan below: Lot Dimensions, Existing Structures, Structure Setbacks, Water Lines, Septic Systems,
Flood Zones, Wells, Shorelines, Easements, Name of Flanking & Fronting Streets. Indicate directional by N, S, E, W, etc.
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRAC-
THE CONTRACTORS REGISTRATION LAW RCW 18.27,AND AM TOR IN THE STATE OF WASHINGTON AND I AM AWARE OF THE
AWARE OFTHE MASON COUNTYORDINANCE REQUIREMENTS ORDINANCE REQUIREMENTS REGULATING THE WORK FOR
FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL WORK WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
DONE WILL BE IN CONFORMANCE THEREWITH. NO CHANGES CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE
SHALLBE MADE WITHOUT FIRSTOBTAINING APPROVAL FROM WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING
THE BUILDING DEPARTMENT. _ DEPA ;MENT.
X OWNER `. 'u' X BY
DATE G Z U 9 37 bo Z 7 S v 5 DATE —� 7
Return permit to: Department of General Services
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 • 427-9670/1-800-562-5628
'FOR OFFICIAL USE ONLY: Accepted by; Date:
Receipt No. Referred To
DEPARTMENTAL REVIEW
FOR OFFICIAL USE ONLY Proposal Proposal
Approved Denied
Planning:
i
Building:
Fire Marshal:
► a3 � �i -- �5- �
Page No. 1 CASE HISTORY FOR CASE NO.: MIS97-0800
PRINCE OF PEACE
y NE1171 SAND HILL RD BELFAIR
12/08/97
Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
------- ------------------------------ -------- -------- -------- --------------------------------------- ---- --- -------- ---
MISA010 Application received / / / / 11/20/97 11/20/97 LLH
MISA050 Approved For Issuance / / / / 11/20/97 DONE LLH 11/20/97 LLH
MISA500 (F) Issue permit / / / / 11/20/97 DONE LLH 11/20/97 LLH
MISB008 Clerical Review & Approval 11/20/97 / / / / DONE LLH 11/20/97 LLH
MISB135 RLC Checklist Review / / / / / / 11/20/97 LLH
w � � �
Buildii-r�j Permit # MASON COUNTY
BUILDING 111 426 W. CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRE TION NOTICE
Job Location "» SY'V �L
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
(E / -/T 0
41? Lg,-?e—S�1? A
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
�i Make corrections, items will be checked on next inspection
❑ OK to
Department /0 i
Date / -2 - 9" _q 7 Inspector T�,Plrf ��-
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