HomeMy WebLinkAboutMIS96-00816 Cancelled Propane - MIS Permit / Conditions - 11/6/2001 Permit No.
MASON COUNTY
+ PLUMBING/MECHANICAL PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 .427-9670
PLEASE PRINT
#1 Owner L T.o n.e S►m> t �1 0� s�rn� Phone# C3 (� 0 ) Y Z(0
Site Address � 5 17 K- S'�
ZIP
City r
Directions to Job Site `r0 of r n
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a h UVLI /h S Cr n
Owner Mailing Address S
St ZIP
City
Lien/Title Holder
Address
St t/lj 14 ZIP
City 2
Cis Contractor Reg. #
#2 Contractor Name Expiration date
Address 0 v V-�-.X Phone
City v r St —Zip
#3 Parcel No.
Legal Description l
'i Describe work
#4 Use of building
�-,
I
#5 Type of Job: New Add Alt Repair
Plumbing Fixtures ($3.25 each) Fee Mechanical Fixtures ($6 50 each)
No. Toilets CIRCLE FUEL TYPE: Gas, Electric,
a Bath Basins
Heatpump, Other
— No. Units
Bath Tubs
_S —
Furn BTU
Showers
} _Hot Water Htr — Heatpumps
—Laundry Washer — Vent Systems
—Sinks — Spot Vent Fans
Floor Drains No. Boilers/Co reSSgrS
HP
_Laundry Basins —
Dishwasher No. Air Handling Units
_Disposal — cfm#
Urinals No. Other 56
t Gas Outlets �_
Other — 32.00
— _ Wood, Gas, Pellet Stove
Permit Basic Fee
16.25
TOTAL PLUMBING $ 16.25
Permit Basic Fee
TOTAL MECHANICAL 01.2�
No Basic Fee for Wood, Gas, Pellet Stove
NOTICE: This permit becomes null and void if work or construction for authorized
re of 180 days at any
within 180 days or if construction or nced
work is suspended or abandoned period
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.
FFF -
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
AWARE OFTHE 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 BUILDING DEPARTMENT.
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
1=C>R OFFICIAL,USE ONLY; Accepted by:
Reept f*to
Referred To
DEPARTMENTAL REVIEW
FOR OFFICIAL USE ONLY Proposal Proposal
Approved Denied
Planning:
I
k
Building:
s
E
I
Fire Marshal:
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CONCRETE MECHANICAL
Footings,-Setback MOBILE HOME
date date by Ribbons
Foundation Walls
by Gas Piping date
b
date - by date b Setup
BG/SLAB Insulation INSULATION date by
date by Floors Final
FRAMING date by date by
date by Walls FIRE DEPT.
PLUMBING date by date by
Groundwork Attic OTHER
date bV date by
D.W.V. WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTION
date by date by
date by
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