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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 Floors Final
date by date by date by
FRAMING Walls FIRE DEPT.
date by date by J 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 date by
•3 L/yE.S r
�R�o ems:
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- Permit No.MC59g� -0a9D
MASON COUNTY
PLUMBING/MECHANICAL PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584.427-9670
PLEASE PRINT
#1 OwnerNeullt&(gk . ' PPhhone#J 360-37 -Y,3K
Site AddressUTG
city St W A zip
Directions to Job Site
Owner Mailing Address nKe _
OR
City `St (��} Zip
Lien/Title Holder � y►�1 E�
Address
City St Zip
#2 Contractor Name fiAuy,S 1"0, T. � Contractor Reg. #HAAIA6— *Ae fQ
ddress ��.5 rAz` - Expiration d
City gar ine'l jaw St ILIA Zip Phone� !- �+
Parcel No. O
"2
Legal Description 9 (- 6LA
#4 Use of building Describe work
>r�e�►en►+�li
#5 Type of Job: New___)( Add Alt Repair
JUN 4 a 1998
Plumbing Fixtures ($3.45 each) Fee Mechanical Fixtures ($7.00 each
No. Toilets CIRCLE FUEL TYPE: (0, Electric,
_Bath Basins Heatpump, Other
_Bath Tubs No. Units 2 e SO Fees
_Showers Furn C/ BT(Je 1'aa
Heatpumps 2£3
_Laundry Washer NET S _ Vent Systems
_Sinks Spot Vent Fans Z6`�
_Floor Drains No. Boilers/Compressors
_Laundry Basins HP
_Dishwasher _ Air Handling Units
_Disposal _ #
_Urinals No. Oth
_Other Gas tlets -->'
u _
Wood, as, Pellet Stove
Permit Basic Fee 1725
TOTAL PLUMBING $ VA
Q0
Permit B Fee a�
_ L MECHANICAL $
• No Basic Fee for Wood, Gas, Pellet Stove
NOTICE: This permit 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 1 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
j THE BUILDING DEPARTMENT. DEPART T.
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
>~C)R OFFICfAI,USE C?NLY Accepted by t7a�fe"
fteceapt No R$ferred To
DEPARTMENTAL REVIEW Proposal Proposal
FOR OFFICIAL USE ONLY Approved Denied
Planning:(Pef G?llnWSn�J7ilA UvIA11crY, � �dIt 144,p- o^F d3t„'/a.f�
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Building: /
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Fire Marshal:
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