HomeMy WebLinkAboutMIS94-0819 #2 - MIS Application - 10/5/1994 Permit No.
mumEo MASON COUNTYO.TLY I /MECHANICAL PERMIT APPLICATION 7
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 • 427-9670
PLEASE PRINT
41 r wner _ F�v Z R 1 Fy2D Phone# 405
Site Address NC ;;Lo 2v655 E(, R-
City NeLi--A IIZ St UJ Zip q<,35-29
Directions to Job Site -.I:N SL& -It, N L ao-i o; = ss� b
Owner Mailing Address 5AE
City sA�C St Zip
Lien/Title Holder )R6e�
Address 5Z Ut}QJ) n"A" �wrlL
City Y PAcV' St-14-&y Zip
#2 Contractor Name o✓ Contractor Reg. #
Address Expiration date
City Sz, St Zip Phone
#3 Parcel No. 1 Z 3 � d'CO C, S v
Legal Description ' rkC CC ; H-e rvLC. , C-a L ,- ; l v Z c.
#4 Use of building Describe work
#5 Type of Job: New Add_Alt Repair_
Plumbing Fixtures ($3 each) EQg Mechanical
No._Toilets CIRCLE FUEL TYPE: as Electric,
_Bath Basins Heatpump, Other
_Bath Tubs No. Unb Fees
_Showers l Furn . lv WO BTU c
_Hot Water Htr Heatpumps
_Laundry Washer Vent Systems
_Sinks Spot Vent Fans
_Floor Drains ND, Boilers/Compressors
_Laundry Basins _ _ HP
_Dishwasher Ng, Air Handling Units
_Disposal cfm#
_Urinals LLQ 4tiLu
_Other Gas Outlets
Wood, Gas, Pellet Stove
Permit Basic Fee 15.00 _ o�.r/L ?1(1( c
TOTAL PLUMBING
Permit Basic Fee 15.00
TOTAL MECHANICAL $_�3
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 OqM p`�f Q 4 1 t jt to be, loc}ted
outside of the existing structures, a plot plan MUST be submitted as required It*o"Y:
'
Show following on the site plan below: Lot Dimensions, Existing Structures, Structure Setbacks, Watgr4jnes, Septic System;:,
Flood Zones, Wells, Shorelines, Easements, Name of Flanking & Fronting Streets. Indicate directional by N, S, E, W, etc.
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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 WHICHTHE PERMITIS ISSUED AND ALL WORK DONE WILL BE IN
DONE WILL BE IN CONFORMANCE THEREWITH. NO CHANGES CONFORMANCE THEREWITH. NO HANGES SHALL BE MADE
SHALL BE MADE WITHOUT FIRSTOBTAINING APPROVAL FROM WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING
THE BUILDING DEPARTMENT. /7) DEPARTMENT.
X OWNER `J)Z ;�/�R. - - /'L a 'y/' X BY
DATE i GI 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: 6 Date:_ !D
Receipt No. (u `) </ Referred To
DEPARTMENTAL REVIEW
FOR OFFICIAL USE ONLY Proposal Proposal
Approved Denied
Planning:
Building:
Fire Marshal: