HomeMy WebLinkAboutMIS98-0153 Propane - MIS Application - 3/24/1998 M C 153
Permit No.
MASON COUNTY
PLUMBING/MECHANICAL PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 • 427-9670
PLEASE PRINT
#1 Owner 6agjK ohs �)4AI C09L15•y Phone#
Site Address l 1 E. 91 D GECRE ST d1�1� tJ
City V St �w)) Zip S`l 02
Directions to Job Site (b 1.r,
LI W n..�,J P 'Nb�..-[9- ul /'bi`Od>�T(�-�-1- C O�ti/t `•� 2 f
1 to V N e.C./'� 6a ([
apc-c� , �C tiv
Owner Mailing Address
City �' (toy\ St Zip
Lien/Title Holder an
Address 410 � &Y, S
City Sb'LT6 St WA ZIP qgrS;?4-
#2 Contractor Name ,S� T C D ill y'TTl_�IJC�- Contractor Reg. #STh1IRE N1o"T f1
Address '1 a0 W IJ SOS 1l7 Expiration date
City OLYMpI?r StXJ_Zip gTSO,-L Phone-560-?to 4-2
#3 Parcel No. 3 Z (y S - :7(- 5OQ 1' I
Legal Description _T A 0£• .SP S wry/ t5 Z (�
#4 Use of building ffOME Describe work
Am r,.,.-.Q -'v
#5 Type of Job: New Add Alt Repair
Plumbing Fixtures ($3.45 each) Fee Mechanical Fixtures ($7.00 each)
No._Toilets CIRCLE FUEL TYPE:QS1Electric,
_Bath Basins Heatpump, Other
_Bath Tubs No. Units Fees
_Showers _ Furn BTU
&_Hot Water Htr _ Heatpumps
_Laundry Washer _ Vent Systems
_Sinks _ Spot Vent Fans
_Floor Drains No. Boilers/Compressors
_Laundry Basins _ HP
_Dishwasher No. Air Handling Units
_Disposal _ cfm#
Urinals No. Other
_Other Gas Outlets G��D
_ Wood, Gas, Pellet Stove 34.00 ,rD
Permit Basic Fee 17.25 p 1-2p
TOTAL PLUMBING $ _
Permit Basic Fee ,V ,�) 77.09�6
o0
TOTAL 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 tg 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.
� lad',�,•-,,.� G�.d��
Sh"P�
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRA&
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
SHALL BE MADE WITHOUT FIRSTOBTAINING APPROVAL FROM WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING
THE BUILDING DEPARTMENT DEPARTMENT.
X OWNE p� X BY
DATE 3 D DATE
Return permit to: Department of General Services
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 • 427-9670/1-800-562-5628
FOR OFFICIAL USE ONLY: Accepted by:', Date:
Receipt No. Referred To
DEPARTMENTAL REVIEW
FOR OFFICIAL USE ONLY Proposal Proposal
Approved Denied
Planning:
Building:
Fire Marshal:
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