HomeMy WebLinkAboutMIS94-00977 Final Wood Stove - MIS Permit / Conditions - 11/29/1994 MASON COUNTY
Mason County Bldg, III 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 b
Foundation Walls date by Set Up
date by INSULATION date by
BG/SLAB Insulation Final
Floors
date by date by date by
FRAMING Walls FIRE DEPT.
date by date by date by
PLUMBING OTHER
Groundwork Attic
date b date by
D.W.V. WALLBOARD NAILING
date by
date by
Water Line FINAL INSPECTION
date by date. / � by Z �J date by
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MASON COUNTY Permit NO.-*-
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BUILDING PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 /►�ZZ� 9 q
PLEASE PRINT `(
#1 Owner t'�A-V l D A, `TR � L-0121 Z COOK, Phone#��,� o�-7�- A5 4 3
Site Address N F 111 S M 1 S S 1 C N r R EF-IZ D A D Fire District#
City GEL EA =R St_ W A Zip L7,q 52 �
Directions to Job Site G 0 17Y-*145R e L F R I tZ ST�47E PA R IL T1 l P&J 1216 wr
. ON M lsSoN ("r—RD . 60 \4 - MOLC- S R-PP2o)(. TuIRW
L E F-T' O N C3 R M t✓L E AS Ir m e t z-r A V D P-E S S .� P O S TE-P�
LJ N '1R r=e ( -TVA E12f S A4 1- T- p i N< Hi fl IZT o K) -T7 z;F— A-LS o
Owner Mailing Address
City St Zip
Lien/Title Holder C H A5 E MAN 44 A TTA N M6l2TC-)A G F— COR P O f2 R ) 10 /V
Address CS et>Cp bit CXC•- 12 D .
City PC) RT 0►2C H—P-R0 St wp� Zip9 83(-O
#2 Contractor Name VJ EP—-Z-T-Ar C 1; Contractor Reg#
Address Expiration Date
City GOiRST St LA�)A _Zip Phone#
#3 If septic is located on project site, include records.
Connect to Septic? Public Water Supply Well
Connect to Sewer System? Name of System
(If residential, proof of potable water is required)
#4 Parcel No. ' 3 - 4-r - o
Legal Description Z-0 7- A 0?= S A-O/ZT P LA T ti 0 • /40.!r
#5 Building Square rootage: (existing/proposed)
1st FI / 2nd FI / 3rd FI / Loft /
Basement / Deck / #bedrooms / #bathrooms /
Garage / Carport / (Circle: Attached or Detached?)
Other sq.ft. /
#6 Use of building o O 1 '�Q't �-C' I -IZX rYt.l Describe work
#7 Type of Job: New Add Alt Repair Other
111
#8 MOBILE/MANUFACTURED HOME INFORMATION
Model Year Make Model
Length Widt# Serial No. NOV 4
# Bedrooms # throoms Type of Heat SERVICES
Purchase Price$ GENERAL'
#9 Indicate by circling the applicable source if any water is on or adjacent to subject property:
River Pond Creek Stream Wetland Lake Marsh Saltwater Seasonal Runoff Other
Show following on the site plan
Lot Dimensions Flood Zones
Existing Structures Fences
Structure Setbacks Driveways
Water Lines Shorelines
Drainage Plan Topography
Septic Systems Wells
Proposed Improvements Easements
Name of Flanking Street Indicate Directional by (N, S, E, W)
Name of Fronting Street in relation to plot plan
APPLICANT TO DRAW SITE PLAN BELOW
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
Plumbing Fixtures ($3 each) Fee Mechanical Fixtures ($6 each)
No. Toilets CIRCLE FUEL TYPE: Gas, Electric,
_Bath Basins Heatpump, Other
Bath Tubs No. Units Fees
_Showers _ Furn BTU
_Hot Water Htr _ 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.. Fire Protection Systems
_Other Auto. Fire Alarm Sys 50�00
Fixed Fire Supp. Sys 50.00
Permit Basic Fee 15.00 _ Auto Fire Sprink Sys 25.00
TOTAL PLUMBING No. Other
Gas Outlets
Wood, Gas, Pellet Stove
NOTICE: THIS PERMIT BECOMES NULL AND VOID IF
WORK OR CONSTRUCTION AUTHORIZED IS NOT COM-
MENCED WITHIN 180 DAYS OR IF CONSTRUCTION OR Permit Basic Fee 15.00
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD TOTAL MECHANICAL $
OF 180 DAYS AT ANY TIME AFTER WORK IS COM-
MENCED. PROOF OF CONTINUATION OF WORK IS BY
MEANS OF A PROGRESS INSPECTION.
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIRE- I CERTIFY THAT I AM A CURRENTLY REGISTERED
MENTS OF THE CONTRACTORS REGISTRATION LAW CONTRACTOR IN THE STATE OF WASHINGTON AND I
RCW 18.27, AND AM AWARE OF THE MASON COUNTY AM AWARE OF THE ORDINANCE REQUIREMENTS REGU-
ORDINANCE REQUIREMENTS FOR WHICH THIS PER- LATING THE WORK FOR WHICH THE PERMIT IS ISSUED
MIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN AND ALL WORK DONE WILL BE IN CONFORMANCE
CONFORMANCE THEREWITH. NO CHANGES SHALL BE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT
MADE WITHOUT FIRST OBTAINING APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING
THE BUILDING DEPARTMENT. DEPARTMENT.
X OWNER X BY
DATE DATE
FOR OFFICIAL USE ONLY: Accepted by: CA Date:
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Fold
Approval
Planning:
I
Environmental Health:
Building Plan Review
I Occupancy Group: Type of Const:
Fire Marshal:
Other:
Special Conditions:
FEES
Building Per �0-0
Plan Check
Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
Site Inspection
Building State Fee
Other
Other
Building Valuation: TOTAL FEE S C�