HomeMy WebLinkAboutMIS97-0755 Adding 7 Bathrooms - MIS Application - 11/3/1997 Permit No.
MASON COUNTY
' PLUMBING/MECHANICAL PERMIT APPLICATION q
426 W. Cedar/P.O. Box 186, Shelton, WA 98584.427-9670
PLEASE PRINT / O
#1 O 5er Phone# „ 40 --.�7a - a 6�oo
ite Addres 4 i6 a -• .E. '
City St Zip
Directions to Job Site l8528
Owner Mailing Addresses/ ���.
City St zip 9'P_"j'—X
Lien/Title Holder
Address
City St Zip
#2 Contractor Name /S � -� Contractor Reg. #1315 YfiE MOW
Address .3�5/6 �(/. D Expiration date_"
City N "I' St �Y # Zip !2f f Phone 04 '0 13 74 3G 3
# arcel No. - -
Legal Description
#4 Use of building LA_ Describe work
#5 Type of Job: New Add Alt Repair
Plumbing Fixtures ($3.35 each) Fee Mechanical Fixtures ($6.75 each)
No.7—Toilets 23.yS CIRCLE FUEL TYPE: Gas Electric,
Bath Basins Z3'1S Heatpump, Other
Bath Tubs No. Units Fee
_Showers _ Furn BTU
-3 Hot Water Htr / 3 Heatpumps
_Laundry Washer — Vent Systems
—Sinks — Spot Vent Fans
_Floor Drains No. Boilers/Compressors
—Laundry Basins HP
. —
Dishwasher_ No. Air Handling Units
—Disposal 0 cfm#
_Urinals No. Other
I OtherLR6 51hl0 3 3 — Gas Outlets
Wood, Gas, Pellet Stove 33.00
Permit B e 16. —
T T MBII�1� ,�77. o�'
Permit Basic Fee 16.75
TOTAL MECHANICAL $An
No Basic Fee for Wood, Gas, Pellet Stove
NOTICE: This per0 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 any
time after work is commenced. Proof of continuation of work is by means of a progress inspection.
NOTE: If 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 required below:
Show following on the site plan below: Lot Dimensions, Existing Structures, Structure Setbacks, Water Lines, Septic Systems,
Flood Zones, Wells, Shorelines, Easements, Name of Flanking & Fronting Streets. Indicate directional by N, S, E, W, etc.
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 RCW 18.27,AND AM TOR IN THE STATE OF WASHINGTON AND I AM AWARE OF THE
AWAREOFTHE MASON COUNTYORDINANCE REQUIREMENTS ORDINANCE REQUIREMENTS REGULATING THE WORK FOR
FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL WORK WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
DONE WILL BE IN CONFORMANCE THEREWITH.NO CHANGES CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE
SHALLBE MADE WITHOUT FIRSTOBTAINING APPROVAL FROM WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING
THE BUILD G. EPARTMENT DEPARTMENT.
X OWNER X BY
DATE DATE
Return permit to: Department of General Services
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 . 427-9670/1-800-562-5628
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DEPARTMENTAL REVIEW Proposal Proposal
FOR OFFICIAL USE ONLY Approved Denied
Planning: W
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Building: W L C-
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Fire Marshal: