HomeMy WebLinkAboutMIS99-0022 Final Gas Oultets - MIS Permit / Conditions - 3/1/1999 MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
V t... t A M F K1 t)c3v F' IF R M i "F FOR INSPECTIONS CALL 427--9670
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MIS99--0022. PARCELr1232.9140001 ;1 PL.A'Ta DIV : BL.K : LOT :
*jOB ADDRF` S : P62 NV Oi F) RF=I FA III IJWY 11FI VA IA
APP1 ICANT : TWII. ' SF=TMIT01141t3602753489 3602756482
OWNLR : 4WI I A Fat I I( V l ON 360?753488 360?756402
LEGAL : it I Of Sfll4 IM4
PRO111=C i DUISC:R I P I I ON w
i' rlatturnl gat; orrt lets , (Ins stove and teat water heater
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r"RO 1ECT LOCATION :
:w'5 miles from "orlbstiore, 01(i bp]--VaIr h*V inler"nocl inr1 :
PR4)JUC1 NOTH'7 :
I YPF AMOUNT BY IAA"TF RF CIF I I'T
Pl 8S $ 20 .00 KKK. 01 / 19i99 133t,
W011-11" * 4f ,00 KKK 01 / 19/u9 1335
PL FF 7 . 00 KKK 01 / 14/99 1335 J
MCFF= # 5 . s10 KKK 01 / 19199 1?,35
TOTA.I : 46 .50 r OWNF l OR AG NT DA1 F
IiIS f�Mt, rev) 441#1197
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CONCRETE MECHANICAL MOBILE HOME
Footings-Setback date by Ribbons
date by Gas Piping date by
Foundation Walls date Set Up
date by INSULATION date by
BG/Sl A 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
D.W.V. WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTION
date by date 3 by 7' date by
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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 Contractor Name /ki S4du P
Mailing A dress V.O, & Mailing Address
City l StateW A, Zip Code Ok7.7& City S V e 1-L State Lv<. Zip Code
Phone(,6 Other Ph. 3( b6 )a75-30 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 digit Tax Parcel No. Fire District
Legal Description
Site Address(Please include street name, street number and city) to
Directions to site . 2s mtes r11.44;v- S e f je
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 1 st Floor 2nd Floor Basement Garage Closet
PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS F�,I94 Type: Electric
Type of Fixture No. of Fixtures Fees LPG Natural Gas Heatpump
_Toilets Type of Unit o. of Units Fees
Bath Basins Furnace
Alath Tubs �_ Heatpumps
Showers ti Vent Fans
Water Heater Propane Tank
Laundry Wsher Gas Outlets
Sinks Wood/Gas/Pellet Stove I
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-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. lln �j first obtaining approval.
X / ► //1' /S.0 Date X Date
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by f<a4ZP Date I C 9C(Submittal Amount Due (1L,`� Receipt No. 31"=
EJEPARLMEiV71E1�#E !(::: :::'.:..::::;.<:::.::APPR [i DENIEDQtt[f�l1l( tIDES
Building Department
Occ Group Type Constr.
Planning Department
Other
Other
--
_.
Permit Fee Site Inspection
Plan Review Fee UFC Plan Review Fee
Plumbing&Base Fee (• Other
Mechanical&Base Fee Other
Wood/Gas/Pellet Stove Fee r1 co Pre-Paid at Submittal ( )
Violation Fee J— TOTAL FEES l_;V