HomeMy WebLinkAboutMIS94-00925 3 Evaporator/Condensor Systems - MIS Application MASON COUNTY BLDG 4277798 P. 03
Permit No.
MASON COUNTNOCT ."d U
PLUMBING/MECHANICAL e4RM IT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton,`)� �27-�
408584 q74-
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PLEASE PRINT
#1 Owner— M'PoLAqU-s �jW. Phone# 8z7 9700
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dress /V,,57,City St Zip
Directions to Jo 6 Site
Owner Mailing Address
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City Kt i-k 1A-J -. Zip-
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Lienfritle Holder
Address
City St —Zip_
#2 Contractor Name 06ntractor Reg.
Address Ce Eipiration date
City Phone-
No.
N Legal Description 1 -al 246 r7
#4 Use of building ')fe-5;Ilea e4 P-a-7 74- —Des6ylbewor 3;
#5 Type of Job: New v" Add—Alt Repair
Plumbing Fixtures ($3 eacb —Peq MgChAn10I.FjX r
No.- Toilets CIRCLE FUEL PE: Ga Electric,
. 1 7
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Bath Basins Heatpump, Othrarlic5:0-
Bath Tubs No. Units Fees
Showers Furn BTU
Hot Water Htr Heatpumps
Laundry Wasiher Vent Syst=ms
Sinks Spot Vent Fans
Floor Drains NO, Boilers/Compressors
I
Laundry Basins HP
Dishwasher No. Air Handiling Units
__Disposal cfm#
Urinals No. Other 1
Other Gas outlets
Wood 134% Pellet Stove 26.00
Permit Basic Fee 1116.00 Agw(
j e-op,le.-- 61�
TOTAL PLUMBING
Permit Basic Fee 15.00
TOTAL MECHANICAL
No Basic Fee for Wood, Gas, Pellet Stove
NOTICE: This permit becomes null and void If work or construction authorized ISr not commenced;
within 180 days or If construction or work Is Suspended or abandoned for a period of 180 days at any,
time after work Is commenced. Proof of continuation of work is by m4ns of a progress inspection.;
MASON COUNTY BLDG 3 4277�79e P. 02
NOTE: l(this permit application includes the placement of a fuel tank, heat,pump or other unit to be located
outside of the existing structures, a plot plan MUST be submitted as requirod below:
Show following on the site plan below: Lot Dimensions, ExistingStructures,
, Structure Setbacks,Water Lines, Septic Systems,
Flood Zones, Wells, Shorelines, Easements, Name of Flanking& Fronting Streets. Indical(e directional by N, S, E, W, etc:
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OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRAC-
THE CONTRACTORS REGISTRATION LAW ROW 18.27,AND AM TOR IN THE STATE OF WASHINGTON AND I AM AWARE OF THE
AWARE OF THE MASON COUNTYORDINANCE REQUIREMENTS ORDINANCE REQUIREMENTS REGULATING THE WORK FOp
FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL WORK WHICHTHE PERMIT IS SSUED ANDALLWORK DONE WILL BE IN
DONE WILL BE IN CONFORMANCE THEREWITH.NO CHANGES CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE
SHALL BE MADE WITHOUT FIRSTOBTAINING APPROVAL FROM WITHOUT FIRST OBTAINING APPRQVAL FROM THE BUILDING
THE BUILDING,DEPARTMENT. DEPARTMENT, i
X OWNER X BY I
DATE ,/ DATE I
Return permit to: Department of General Services
426 W. Cedar/P.O. BOX 186, Shelton, WA 98584 . 427-9670/1-800-562-5628
- +FC7?�QFFICIAt USE rJNLY:.A cce p ted.Ij .t�- i a ..>
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.. date ..
;Lipt No
Referred To ' �' R `� (
—TEL Elm
DEPARTMENTAL REVIEW
FOR OFFICIAL USE ONLY Proposal Proposal.
Approved Denied
Planning:
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Building: i
Fire Marshal:
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