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Home My WebLink AboutCOM2000-00022 Suite J Utilites and Partition - COM Permit / Conditions - 4/10/2000 MASON COUNTY PERMIT ASSISTANCE CENTER 1f1SPeL;uvn Line Phone: (360)427-9670, ext. 352 Mason County Bldg. 3 426 W. Cedar P.O. Box 186 ' Shelton, WA 98584 1 COMMERCIAL BUILDING PERMIT COM2000-00022 OWNER: TGF HAIRCUTTERS RECEIVED: 03/16/200 CONTRACTOR: TGF HAIRCUTTERS ISSUED: 04/10/200 SITE ADDRESS: 23969 NE STATE ROUTE 3 SUITE I BELFAIR EXPIRES: 10/10/200 PARCEL NUMBER: 123294190021 LEGAL DESCRIPTION: TR 2-A OF NE SE TR A OF SP#423 PCL 1 OF BLA 98-58 `0r1 PROJECT DESCRIPTION: DIRECTIONS TO SITE: �G`i►P`�P� ADD ELEC AND PLUMB AND PARTITION WALL FOR SAFEWAY CENTER IN BELFAIR OVID HAIR SALON General Information Construction & OccupaWdy Information Ins Area: 1 No. of Units: Type of Constr.: 5N Type of Use: p• No, of Bathrooms:. Occ. Group: B Type of Work: ALT Fire Dist.: 2 No of Stories: 1 Occ. Load: 96 Valuation: Building Height: Pre-Manufactured Unit Information Square Footage Information Make: Length: Lot Size: odel: Width: Building: 1,200 Year: Serial No.: Basement: Parking Spaces: Setback Information Shoreline & Planning Information Front: Ft. Shoreline: Ft. Rear: Ft. Slope: Ft. Water Body: Shoreline Desig.: Side 1: Ft. SEPA?- Comp. Plan Desig. Side 2: _dam_ Ft. Fire Protection System Information y r Emer enc Ke Box?: Stand i e?: Pttito Fire Alarm System.: 9 Y Y p p Auto Fire Sprinkler System?: Access Road?: Fire Extinguishers?: Fixed Fire Suppression System?: Fire Hydrants?: Fire Lanes?: COM2000-00022 Please refer to the following pages for conditions of this permit. 1 of 3 L Plumbing Fixtures Mechanical Fixtures FEES Type Qty. Type Qty. Type By Date Amoun Receipt Kitchen Sink 4 Plan Check Fee KLW 03/16/200 $42.00 1830 Water Heaters 1 Address Fee GMM 03/17/200 $15.00 BELFAIR Clothes Washer 1 Building State Fee SKM 04/03/200 $4.50 BELFAIR Building Permit Fee SKIM 04/03/200 $42.00 BELFAIR Plumbing Fee SKIM 04/03/200 $42.00 BELFAIR Plumbing Base Fee SKM 04/03/200 $20.00 BELFAIR UFC Plan Check Fee DLS 04/03/200 $21.00 BELFAIR Environ. Health Plan CEW 04/06/200 $50.00 BELFAIR �80%s. Energy Code DLC 04/07/200 $21.00 BELFAIR Total $257.50 This permit becomes null and void if work or construction authorized is not commenced within 180 days, or if construction or work is suspended for a period of 180 days at any time after/,work is commenced. Evidence of continuation of work is a progress inspection within the 180 day period. Final inspection must be approved before building can be occupied. � /j OWNER OR AGENT: \\ DATE: CASE NOTES FOR COM2000-0002 1) COM2000-00022 Please refer to the following pages for conditions of this permit. 2 of 3 CONDITIONS FOR COM2000-00022 1) Approved per dimensions and setbacks on submitted siti an XV 2) CONSTRUCTION PROCESS TO BE FIELD CORRECT EQUIRED PER MASON COUNTY BUILDING DEPARTMENT AND UNIFORM BUILDING CODE.x 3) Changes to approved building plans that affect compliance to the current non-residential Energy Code (NREC), ventilation and Indoor Air Quality Code (VIAQ) Uniform Building/Plumbing/Mechanical Codes and/or Mason Cou t / gulations shall be approved prior to construction. X z �� 4) ALL CONSTRUCTION MUST MEET OR qXCEED ALL LOCAL CODES AND UBC REQUIREMENTS AND OCCUPANCY IS LIMITED TO THE PERMITTED AND APPROVED CLASSIFICATION. ANY CHANGE OF USE OR OCCUPANCY WOULD RES11 PERMIT REVOCATION. CHANGE OF USE MUST BE APPROVED PRIOR TO CHANGE. x ✓�`� 5) All approved plans are required to be on-s�e for inspection purposes. If inspection is called for and plans are not on site, Approval WILL NOT be granted. Irv,ddition, a Re-Inspection fee in the amount of$42.00 per hour (minimum 1 hour) will be charged and mint lected by this department prior to any further inspections being performed or approval granted. X� e, 6) PURSUANT TO 1997 UNIFORM BUILDING CODE, ALL SITES MUST HAVE APPROVED NUMBERS OR ADDRESSES PROVIDED IN SUCH A POSITION AS TO BE PLAINLY VISIBLE AND LEGIBLE FROM THE STREET OR ROAD FRONTING THE PROPERTY. MASON COUNTY BUILDING DEPARTMENT REQUIRES THAT THIS BE COMPLETED PRIOR TO CALLING FOR ANY SITE INSPECTIONS. A REINSPECTION FEE, BASED ON RATES AS ADOPTED BY THE JURISDICTION AND THE 1997 UNIFORM BUILDING CODE WILL BE AS S ED IF OWNER/CONTRACTOR FAILS TO POST ADDRESS ON SITE PRIOR TO REQUESTING INS11c TIO S. X 7) 1. TENANT IMPROVEMENT MAY REQUIRE MODIFICATION OF THE FIRE SPRINKLER SYSTEM AND THE FIRE ALARM SYSTEM. TENANT IS ADVISED THAT CREATION OF UNPROTECTED SPACES MAY DELAY THE APPROVAL FOR OCCUPANCY. IT IS THE TENANT OR OWNER'S RESPONSIBILITY TO ASSURE THAT FIRE PROTECTION SYSTEMS ARE COMPLETE. COM2000-00022 Please refer to the following pages for conditions of this permit. 3 of 3 i CONCRETE MECHANICAL MOBILE HOME Foot' a Sei�ack date by Ribbons date _ _ by Gas Piping date b Foundation Walls date b Set Up i dates by INSULATION date by BG/SLP:8 Insulation Floors Final date by date by date by FRAMING Walls FIRE DEPT, date by PLUMBING date by date by Attic OTHER Groundwork date by date by D.W.V. WALLBOARD NAILING date by �/T date by Water Line FINAL INSPECTION date by by 7:72 date by date by I fi s C Building Permit # MASON COUNTY j BUILDING 111 426 W. CEDAR ` SHELTON, WASHINGTON 98584 (360) 427-9670 CORRECTION NOTICE Job Location f= Z3 s"i`3 j 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 za-vT J`,F�T !vl w�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 Department Date 'Z 7 <n<:5 Inspector J . moss NOT MOV TH11%h TAL Building Permit # 6157,'f 2 4"3� — MASON COUNTY BUILDING 111 426 W. CEDAR . SHELTON, WASHINGTON 98584 (360) 427-9670xT 2k!�;2— CORRECTION NOTICE Job Location %G/: 2,3�6 si Ri .3 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 i) �i9 ��-/Gh i S t-✓��7' ?.�'�i% Ty �ivc cf� F/�.Si S� �� Xi�,� s 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 l/CCC-ZZ :Z2-C, S ❑ This is not a c6fnplete insp ction Department 2CIO Date Inspector 'fr, ■ io4 s NOOT MOV THIC TmLoqi PERMIT NO.: fti�,_a -B3DZZ MASON COUNTY l BUILDING PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner Contractor Name _t1 O CP Mailing Address 8-qwi sf 682'' r1_v7t./y9 Mailing Address ///d f JK City Is,,~State Ad-4 Zip Code ^Pcwo City State &wi Zip Code PhoneGWd Other Ph.(_j Ph. lj ,XS 8Se--W3�3Dther Ph.( Lien/Title Holder Contractor Reg. # SDFCo* 4'/gdd 9 Address — Expiration SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System Well Water System Name of Water System elee1 7if,4 PARCEL INFORMATION-12 digit Tax Parcel No. 1 9L,3 ag / 4 dC<- Fire Dis�x+et Legal Description .:i"?S ' f_ x�✓ii9�J� A ,eT/- 46-9 q o o 2 I 18 f Site Address(Please include street name, street number and city) Directions to site X-V/A40-OY Cd v70rf iiv Will timber be cut and sold in parcel preparation? (Yes/No) 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 1-1,*E 5Wdc4.0 Describe Work Aop ei < .r, tot/ No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st Floor/060 Z118'F"Our--- 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached Carport Attached Detached MOBILE HOME INFORMATION-Make Model Model Year Length Width Serial No. No. of Bedrooms No. of Bathrooms Type of Heat Purchase Price $ Replacement Unit ?(Yes/No) Installer Name Certification No. 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-I 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 conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval. first obtaining approval. X ��/ /!� Date ?-1A1-XW 0 X Date j FOR OFFICIAL USE BEYOND THIS POINT I Accepted by Dates (S O Submittal Amount Due !l`/1S o Receipt No. I DEPARTMENTAL: REV(EW APPROVED ;'DENIED CONDITION CODES Building Department 3-m Occ Grou Type Constr.�-N Planning Department Environmental Health Department Public Works Department i Fire Marshal Valuation $ FEES Building Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee Plumbing & Base Fee Public Works Review Fee Mechanical & Base Fee Other n/ c� ��sv Wood/Gas/Pellet Stove Fee Other Violation Fee Pre-Paid at Submittal <ri> T OTALFEES corn PERMIT NO.: MASON COUNTY BUILDING PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner Contractor Name Mailing Address Mailing Address u City State Zip Code City State Zip Code Phone( ) Other Ph.( j Ph.( Other Ph.( Lien/Title Holder Contractor Reg. # Address Expiration SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System Well Water System Name of Water System PARCEL INFORMATION-12 dig�Tax Parcel N Fire DtJlt t Legal Description—FV-A,M4 Y1 T12` 9 - J Site Address(Please include street name, street number and clty) erections to site z Will timber be cut and sold in parcel preparation? (Yes/No) 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 11-00,of 5Wt-.a. Describe Work No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st Floor 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached Carport Attached Detached MOBILE HOME INFORMATION-Make Model Model Year Length Width Serial No. No. of Bedrooms No. of Bathrooms Type of Heat Purchase Price $ Replacement Unit ?(Yes/No) Installer Name Certification No. 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-I 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 conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval. first obtaining approval. X Date X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED CONDITION COt7E$ Building Department Occ Group Type Constr. Planning Department .3111 Environmental Health Department Public Works Department Fire Marshal Valuation $ .. FEES . Building Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee Plumbing & Base Fee Public Works Review Fee Mechanical & Base Fee Other Wood/Gas/Pellet Stove Fee Other R� 0 Violation Fee Pre-Paid at Submittal ( ) TOTAL FEES :....:.:.:...............,..:...........: .....:.......:.. :::::::...::::::.�::...; ieY': �' 151SD2,2 PERMIT NO.: 131.8 MASON COUNTY BUILDING PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner y: Contractor Name Mailing Address Mailing Address City State :r Zip Code ,$Pr, City State Zip Code Phone(' -! ) Other Ph.( ) Ph.(, , ) Other Ph.0 Lien/Title Holder Contractor Reg. # 4 + w r -•'n':? 7 Address Expiration SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System Well Water System Name of Water System PARCEL INFORMATION-12 digit Tax Parcel No. / / Fire District Legal Description - ,Z Site Address(Please include street name, street number and city) Directions to site c'ar'yrtT ; '• rN .r�salr:tiL� Will timber be cut and sold in parcel preparation? (Yes/No) 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 IW*A' S. .1 G.c. Describe Work r,� � is r r. .,,. ... c .< . `.;. a�� ,-r:•' r, .v>F ,Ys)rcic+ No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st Floor 2nd`Flaor----- 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached Carport Attached Detached MOBILE HOME INFORMATION-Make Model Model Year Length Width Serial No. No. of Bedrooms No. of Bathrooms Type of Heat Purchase Price $ Replacement Unit ?(Yes/No) Installer Name Certification No. 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-I 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 conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval. first obtaining approval. X i' Date X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date < Submittal Amount Due Receipt No. DEPARTMENTAL REVIEW APPROVED »DENIED CONDITION CODES Building Department Occ Group Type Constr. Planning Department Environmental Health Department Public Works Department i Fire Marshal Valuation $ FEES Building Permit Fee Site Inspection Plan Review Fee -• UFC Plan Review Fee Plumbing & Base Fee Public Works Review Fee Mechanical & Base Fee er CrvV /J & Wood/Gas/Pellet Stove Fee Other Violation Fee Pre-Paid at Submittal ( ) ><` TOTA L FEES PERMIT NO. MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair(360)275-4467 Elma 360 482-5269 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner Contractor Name SO."CazP Mailing Address Pyy,, of"y Mailing Address 0,1a F LK SVio, City State - Zip Code 'r-ati o City-2,; State Zip Code 0,2 Phone e,e tit.-k• Other Ph.( Ph. y( �7 t h e r Ph.0 Lien/Title Holder Contractor Reg. # SO<CO-jv*1.1 d L.7 Address Expiration SEPTIC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System d9C?fq/X PARCEL INFORMATION-12 digit Tax Parcel No. / V / OOC + < Fire District Legal Description f xr/i�7-5, ,-9, , 6-ems Site Address(Please include street name, street number and city) Directions to site .,7.wjfw.so,5, �E, r;r_- ,5'FL1=�/� 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 i e_A C� c Location of Fixtures/Units 1st Floor 2nd Floor Basement Garage Clos t PLUMBING FIXTURES(Show Number of each) MECHANICAL 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 Heatpumps Showers Vent Fans %LVater Heater 7 Propane Tank Laundry Wsher 7 Gas Outlets Sinks ze Wood/Gas/Pellet Stove Dishwasher Direct Vent? Other Other Other Other Base Fee j-,�k — Base Fee TOTAL PLUMBING q7- - 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-I 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 conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval. first obtaining approval. X /, Date X Date P�0L, FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. � L\ iJE AR1 ItiAEi+1T11E: 21 V# ViF'> 1tiF#�E�?tEE .... DENI i3 0..0ttff}l!14fN cots: Building Department Occ Group Type Constr. Planning Department Other Other FEES 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 FORM MUST 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)275-4467 Elma 360 482-5269 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner iG/ /�i4i�'c'v1Ts ma's Contractor Name 5'0i= doe.f, Mailing Address bryyisr dzfv '' Mailing Address./z/.�, /-- Lip Sf7i�i�,r.y �Cw S' City State .=lJn Zip Code 'j,z, v,c, State a q Zip Code "V,2 j' Phone "ee .ifs--!�yve Other Ph.( Ph.(y,2S) ff3 -hr6y,;bther Ph.0 Lien/Title Holder — Contractor Reg. # Address — Expiration SEPTIC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System A3Fe1i.W1' PARCEL INFORMATION-12 digit Tax Parcel No. MCA /�_/ hCr, t C, Fire District Legal Description .S ,-- fJ�7s /9_ /f� Site Address(Please include street name, street number and city) Directions to site 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 t rx Repair Other Use of Building I 7e-�C4_�� Location of Fixtures/Units 1st Floor 2nd Floor Basement Garage Clos t PLUMBING FIXTURES(Show Number of each) MECHANICAL 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 Heatpumps Showers Vent Fans Water Heater i Propane Tank Laundry Wsher / Gas Outlets Sinks / Wood/Gas/Pellet Stove Dishwasher Direct Vent? Other Other Other Other 3 Base Fee Base Fee TOTAL PLUMBING 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-1 certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I 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 conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval. > first obtaining approval. X // /ice Date Y Z c,v X Date FOR OFFICIAL USE BEYOND THIS POINT t Accepted by 5 Receipt No. Date � C Submittal Amount Due �• p tJPART(iA1TAE: iViEV�t 7f?#'RO1lty. IyEREIl -- Ck�.ftjRiTff7tCODE5: Building Department Occ Group Type Constr. Planning Department Other Other FEES 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 ( a ) Violation Fee TOTAL FEES PERMIT NO.: MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner Contractor Name Mailing Address Mailing Address City State Zip Code City State Zip Code Phone( Other Ph.( Ph.( ;Other Ph.(� Lien/Title Holder Contractor Reg. # _c Address Expiration SEPTIC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION-12 digit Tax Parcel No. / / Fire District Legal Description Site Address(Please include street name, street number and city)gp2,159toll f) E Z. Directions to site 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 Type: Electric Type of Fixture No. of Fixtures Fees LPG Natural Gas Heatpump Toilets Type of Unit No. of Units Fees Bath Basins Fumace Bath Tubs Heatpumps Showers Vent Fans Water Heater I Propane Tank Laundry Wsher Gas Outlets Sinks Wood/Gas/Pellet Stove Dishwasher Direct Vent? 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/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-1 certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I 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 conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval. first obtaining approval. X Date 7-/f/-2,o.x-1 X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. -. . I"JiRlFitdE11FM ...... :- Fi Building Department Occ Group Type Constr. Planning Department Other Other ::.. ------ Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee Plumbing&Base Fee der Mechanical&Base Fee Other Wood/Gas/Pelle4 Stove Fee Pre-Paid at Submittal Violation Fee TOTAL FEES