HomeMy WebLinkAboutMIS94-00266 Mechanical - MIS Permit / Conditions - 5/17/1994 2pOw
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MASON COUNTY ELDG 3 4277798 P� 02
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Permit No .
9*94 SON COUNTY
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# ECHANICAL. PERMIT AP LtCAT{O
tom" 426 W.Cedar/P.O. Sox lea,Shelton,WA 98584.427-9670
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PL�ASS PRINT jil t�11—
L Phone#'
#1 Owner
Site Address St Zip 85
City i
Directions to Job Site
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I Owner Mailing Address St s.. Zip g8
I City ' i
Lien(Title Holder '
4 Address St Zip
City CQI ntractor Reg.#
Contractor Name Eitpiration date 9
Address V!✓ 9.
City = St't�AtAZp g Ca ,Phone
Legol Description Des Bribe work
# se'of building
#5 Uof Job: News^Add Alt _Repair ;
F
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CIRCLE FUEL TYPE: Gas,Electric, .
! No..Toilets
Heatpump,Other.
_Bath Basins -- -- ;i
>� ni ;
Bach Tubs Furn___�__._—BTU
Showers Heatpum�s
_ Hot Water Htr -
Vent SysI ems
1 Laundry Washer - Spot Vent Fans
i _Sinks
Floor Drains HP
i ,Laundry Basins
Air 14and0na Units
I _Dishwasher cfm#—J,— _ —
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` Disposa
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`Urinals
_ Gas Outlets
1 Other_.._.. Wood,Gas, Pellet Stove '
14
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15.00
Permit Basic Fee — 2 all.
I TOTAL PLUMBING
Permit Basic Fee 15.00
I TOTAL MECHANICAL
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` : This ermit becomes null and void if work or construction authorized is not commenced
OOTICE. P
a...�.•et*i��tinx+nr we+rk 15 t.tsnended or abandoned for a period of 180 days at arty'
outside of the existing structures, piU Irldl 11vlu.;P I UV ""�� '��►�"-- -
Show fol[Qwing on the site plan below:LQt Oimenslons, Existing Structures,Structure Setbacks,Water Lines,Septic Systems,
Floyd�or►es,Wells,Shorelines, Easemeinis, Name of Flanking&Fronting Streets. indicate directional by N,S. E,W,etc.
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1 CONTRACTORS AFFIDAVIT i
OWNERS AFFIDAVIT '
1 CERTIFY THAT I AM EXEMPT FROM THI REQUIREMENTS OF t CERTIFY THAT OF AM ONTLY AND AM WREGISTERIEARE OF THE
THE CONTRACTORS REGISTRATION LAW RCW 1&27,AND AM TOR IN THE K Et�LL BE IN
AWARE .IFTNEMASONCOUN1YORD CEREQUIReMENTS ORDINANCE REMIREMENTS R p��wN T �� D
FOR WHICH THIS"PERMIT IS ISSt11rE3�0 THAT All WORK WHICH TH PLRM# .E 1. NO CHANGES SHALL
OONE Wtll B IN CONFORMANCE'S THEREWITH NO CHANGES CONFORtul
OVAL FROM THE BUILDI
SHALLBE MADE WITHOUT FIRST OBTAI ING APPROVAL FROM DEPART F# OB WING
THE BUILDING DEPARTMENT.
X SY
X OWNER
{ DATE I
DATE
Return permit to: Department of General Services
426 Wt CedarlP.0. Box 186, Shelton,WA 98584. 427-9670l1-800-562-5628
FICIAL USE ONLY: Accept byl r ,. \,, ::�« '•; ,.
Referred"To
DEPARTMENTAL REVIEW Proposal Proposal '
FOR OFFICIAL USE ONLY Approved Denied
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Planning: I
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8uliding:
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i Fire Marshal:
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