HomeMy WebLinkAboutMIS92-0127 Final Woodstove - MIS Permit / Conditions - 11/16/1992 MASON COUNTY
Mason County Bldg, 111 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
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CONCRETE MECHANICAL MOBILE HOME
Footings-Setback date by Ribbons
date by Gas Piping date by
Foundation Walls date by Set Up
date by INSULATION date by
BG/SLAB Insulation Floors Final
date by date by date by
FRAMING Walls FIRE DEPT.
date by date by date by
PLUMBING OTHER
Groundwork Attic
date by date by
D.W.V. WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTI
date by date/ , by! date by
uu.Ltly� r�tC1v111 �1t'YLll,f�11V1�
PLEASE PRINT "
#1 Owner TI M h'/!"��'��c ��;v��i�r��' Phone# .2 0 G - 2 7 5 - c7/S 6
Site Addres i-27 / nA 73"t'^
City-- Pia r- am St Wd Zip 2 e
Directions to Job Site & 4)?P f o VL�- 11VfiPL- Jac r/ucN�-�z Li'
Owner Mailing Address /2/ dl?
City ji`ct L=Aiie St VVA Zip 9 f- SZ k
Lien/Title Holder S o O C t- o�v�
Address /'0 13,)A J Iro o
Cit Jf1t.Z J St_M16tyic/7i✓ -zip 41'e21) i�oo
#2 Contractor Nameffi(1 Contractor Reg#
Address Expiration date
City St Zip Phone
#3 If septic is located on project site, include records.
Connect to Septic? Public Water Supply Well
(If residential, proof of potable water may be required)
#4 Parcel No.— _ - /.2 -?305200vo.5
Legal D�;9Cr� On�Ly'7s) �" ON l�LAR1)J C VL= n/D. S� AS RC¢OA'U !N VyLUM�
#5 Building Square Footage: (existing/proposed)
1st Fl /VU / 2nd Fl IVA 1 3rd Fl n1l / Loft �'✓/ /
Basement / Deck ' / #bedrooms_ #bathrooms__
Garage / Carport / (Circle: Attached or Detached?)
Other sq ft /
#6 Use of building Describe work
� II
# Type of Job: New Add Alt Repair Demolition
Woodstove�_ Re-Roof Bulkhead Other
#8 MOBILE HOME INFORMATION
Model Year Make Model
Length_ Width Serial No.
#Bedrooms #Bathrooms Type of Heat
#9 Any water on or adjacent to property: saltwater lake
river pond wetland seasonal runoff
other
Lot Dimensions Flood Zones '
Existing Structures Fences
St•Lucture Setbacks Driveways
Water Lines Shorelines
Drainage Plan Topography
LName
c Systems Wells
sed Improvements Easements
of Flanking StreetScale•of Fronting Street '
Date:
APPLICANT TO DRAW SITE PLAN BELO
i
APPLICANT TO DRAW TOPOGR.ApHy PROFILE BELO
I
I
I
I
i
Toilets
Vent Systems X 3 . 00
Bath Basins
Bath Tubs
Vent Fans X 3 . 00 _
Showers No. Boile /rs C
ampressors
Hot Water Htr 0-3 HP 6 . 003 -15 HP
Laundry Washer 15-30 HP �
Sinks _
�
30-50 83? _
Floor Drains 50 + Hp —6_
—Laundry Basins --GAO
Dishwasher No. Air Handling 'Unit
<- 10000 cfm.
Disposal—Urinals > 10000 cfm.
7 5�
� Other
Other
Evap Coolers
Hoods
Permit Basic Fee _ 3 . 0� Fire Suppression
TOTAL PLUMBING $
Domes . Incin.
Comml . Incin.
Mechanical Fixtures Reloc/Repair 6_00
No. Fuel Types
Gas Outlets X 2 . 00 Furn < 100K BTU �Woodstove
�Bara P
— 6 . 00 Furn >a 10OK BTU 6 . 00 Other —'
Furn - Floor 6_00 Permit Basic Fee
Heat Pumps 1 0
6 . 00 TOTAL MECHANICAL $
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 ANYTIME AFTER WORK
IS COMMENCED
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE
CONTRACTORS REGISTRATION LAW RCW 18.27 AND AM AWARE I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR
IN THE STATE OF WASHING
OF THE MASON COUNTY ORDINANCE REQUIREMENTS FOR WHICH U AND I AM AWARE OF THE
THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN HE PE ORDINANCE REQUIREMENTS REGULATING THE WORK FOR WHICH
T
CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE THE PERMIT IS ISSUED AND ALL ARK DONE WILL BE IN
CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE
WITHOUT FIRST OBTAINING APPROVAL FROM
DEPARTMENT. KE BUI MG WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING
DEPARTMENT.
X OWNER
BY
DATE _ _ 2 X DATE
Return permit to: Department of General Services
426 W. Cedar/P.O. Box 186, Shelton, PTA 98584 427-9670/1-800-562 -5628
FOR OFFICIAL, USE ONLY: Accepted by: Date:
Approved Cond Hcid
Approval "
Planning:
f�
I
I
Environmental Health:
Building Plan Review:
Occupancy Group:
Fire Marshall:
Other:
•
FEES
11Special Conditions: II 11site Inspection I II
11 II Ii ;1
11 11 I(Building Permit I II
II 11 (1violation Fee I 11
II 1
11 I
II 11 I1Violation Investigation Fee 1 11
Il 11 II Plan Check I II
I(
I( I. �1
II i
II 11 II Plumbing Fee I i1
11
11 11 11Mechanical Fee 1 II
II 11 H '1
II
ii 11 IlWoodstove Fee
II
11 I' '1
I� 11 IlBuilding State Fee 1 11
'I I
building Valuation: 11 11 TOTAL1 ri C, 11