HomeMy WebLinkAboutBLD2002-01215 Final LPG Tank, Stove, Outlets - BLD Permit / Conditions - 9/23/2002 FORM MUST BE COMPLETED IN INK PERMIT NO.:
PLEASE PRESS HARD MASON COUNTY
PLUls BINGIMECHANICAL 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
APPLICA T INFORMATION _ CONTRACTOR INFORMATION
I Owner L-131EPJ E . L I ND Contractor Name �\1r,i ctAure_°t C
I Mailing Address .O. O 2 ,Mailing Address
City O T COAU State W Zip Code City State Zip Code
Phone O 271 $19�i Other Ph.( === I
Ph.( ) Other Ph.(
Lien/Title Holder_\NSL-L5 �A[<Go Home' MOR-( Contractor Reg. #
Address Expiration
ASEPTIC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of
Sewer System
PARCEL INFORMATION-12 digit Tax Parcel No. 6X / G00q Fire District
Legal Description
Site Address(Pleas Include street name, street number and city) 15L) N 5AB 27- 13E ]R
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 Furnace
Bath Tubs Heatpumps
Showers Vent Fans
Water Heater Propane Tank
Laundry Wsher Gas O,u�tl is lC� '
Sinks Wood/(g)Pellet Pellet Stove
Dishwasher Direct Vent?
Other Other
Other Other
Base Fee Base Fee `�2
TOTAL PLUMBING TOTAL MECHANICAL -1'®
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 therewi . No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without
appr first obtaining approval.
X �� Date /2- 0 2- X Date
FOR OFFICIAL USE BEYOND THIS POINT
c�
Accepted by Date Submittal Amount Due G'l Receipt No. _]
QPARTMENT 'iiElllE1N RPRCJVED DENIEL3 CANRiTI(31�t:�flD>~S
Building Department
Occ Group Type Constr.
Planning Department
Other
Other
SEES
. ... ............. .
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