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HomeMy WebLinkAboutMIS95-0699 Cancelled Propane - MIS Permit / Conditions - 9/8/1995 Permit No. MASON COUNW 4215 W.Cedar/P.O.Box 186,Shelton,WX98584.427-9670 PLEASE PRINT ' #1 Owner W 5 Z ?1Y Phone# Site Address 02.5 City <;.: t Zip Di r ions to Job Site I It ts Owner Mailing Address C> O City St Zip Lien/Title Holder Address City St Zip #2 Contractor Name Contractor Reg.# Address Expiration date City St Zip Phone #3 Parcel No, qD Legal Descriptro�i ! L #4 Use of building Describe work #5 Type of Job:New. Add Alt Repair Plumbing Fixtures(t3 each)- - fM Mechanical Fixtures JW each) No. Toilets CIRCLE FUEL TYPE: Gas, Electric, _Bath Basins Hea*mp,Other Bath'Tubs M4. S,lG& EM Showers _ Furn BTU _Hot Water Htr — Heatpumps _Laundry Washer — Vent Systems Sinks Spot Vent Fans _Floor Drains Ng,, Boilers/Compressors Laundry Basins HP _Dishwasher Ng, Air Handling Units Di§posal _ cfm# Urinals 1`14, Other _Other Gas Outlets / Wood ellet Stove Cg Permit Basic Fee 15.00 1y' roy*)`a Z2,66 TOTAL PLUMBING $ — Permit Basic Fee n-- TOTAL MECHANICAL $ NOTICE: This permit becomees Mali and void-if work or construction authorized is not commenced within 180`days or if constriction or work is suspended or abandoned for a period of 180 days at any time after work is commIernced. 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 beaocated outside of the existing structures, a plot plan MUST,be submitted as required below: Show following on the site plait below:Lot.Dimensions,Existing Structures,>at dpre Setbacks,;Watert iries, Septic Systems, Flood Zones, Wells, Shorelines, Easements; Name of flanking Fronting Streets. Indicate directional by N, S, E,W, etc. 1,74 -76 j 2 a*c I j� OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF 1 CERTIFY THAT I AM'A CURRENTLY REGISTERED CONTRAC- THE CONTRACTORS REGISTRATION LAW_RCW t 8.27,AND AM; TOR 44 THE STATE OF WASHINGTON AND I AM AWARE OF THE AWARE OF THE MASON COUNTY,,QRDINANCEREQUIREMENTS ORDINANCE REQUIREMENTS REGULATING THE WORK FOR FOR WHICH THIS PERMIT 1 IaSUED AND THAT ALL WORK WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN DONE WILL BE IN.CONFORMANGE THEREWITH.NO CHANGES CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE SHALL BE MADE WITHOUT FIRSTOBTAINING APPROVAL FROM WITHOUT FIRST OBTAINING APPROVAL FROM THE,BUILDING THE BUILDING DEPARTMENT. DEMITMENT. X OWNER X BY DATE DATE ''t Return permit to: Department of General Services 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 . 427-9670/1-800-562-5628 '�::`.:..+r' a:. �.6j..r. �•�� Y ":::..�.'nk.a:;ti �,•�Y,.'� .s.:. we • *` EM r k a 3 S::r r z ybe 'ry�z r 3 �• s r YNJ' n.x...�A .�''` k Y .S 6Y •� `d i#5 Y�.��;_: .�u � Y P} '.%� '.�%A ' � Yr 5 Ri ;"5-isy r 3rs' a YTQ � f'ry n Y DEPARTMENTAL REVIEW FOR OFFICIAL USE ONLY Proposat Proposal Approved Denied i Planning: s , Building: i i Fire Marshal• ,. .. ID 0 w to m -i m m M tt-'} Rt f► N! 4b 61! Cl) < n tri Kl C7 W Q4 rn > rnz � 0 0 _ .. .. -} Lit N rn I � Ntnadosin C m C � M as �• o U » pV3Go z w C9 .mac =Z j r rmm t LSii� tlR �31 d ;— I 0 Qi QD CO +1Q�`V '� `� > A + co CD OD CD -! N N .. +. ., m Lit iit L1t SAS "` !!!C1! 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