HomeMy WebLinkAboutMIS94-0067 - MIS Permit / Conditions - 2/14/1994 cn
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CONCRETE MECHANICAL ,` � MOBILE HOME
Footings-Setback date �— r6- 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 b
PLUMBING date by OTHER y
Groundwork Attic
date by 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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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 FRAMING by date by date by
Walls FIRE DEPT.
date PLUMBING by date by date by
Attic OTHER
Groundwork
date by 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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1
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� ►'v �, -e h S ✓t Phone# ��
Site AddresJJ�s� Ct
City �/�C' �_1,YA St 1111A
Directions to Job Site c-cJ c
►''OS �f IS la S"
v� 0 / /t
Owner Mailing
City /'t e / Pror CiL1 St
Lien/Title Holder
Address �--
City St Zip
#2 Contractor Name c-c- �' Contractor Reg. #
Address Expiration date
City %Gt St Zip Phone
#3 Parcel No.
Legal Description Gf r 'O D 71
#4 Use of building ` nGt C Describe work __�__ S u /C
#5 Type of Job: New _Add Alt Repair
Plumbing Fixtures ($3 each) Fee Mechanical Fixtures ($6 each)
No._Toilets CIRCLE FUEL TYPE: Gas, Electric,
_Bath Basins Heatpump, Other
_Bath Tubs No Unija
_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 Handlina Units
_Disposal _ cfm#
_Urinals No Other
_Other _ Gas Out __ �
J Woof_Gas,Aas, Ilet Stove
Permit Basic Fee 15.00
TOTAL PLUMBING $ _
Permit Basic Fee 15.00
TOTAL MECHANICAL $
C
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 CONTRA&
THE CONTRACTORS REGISTRATION LAW RCW 18.27,AND AM TOR IN THE STATE OF WASHINGTON AND I AM AWARE OF THE
AWAREOFTHE 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 CHANGES SHALL BE MADE
SHALL BE MADE WITHOUT FIRSTOBTAINING APPROVAL FROM WITHOUT FIRST OBTAINING APPROVAL FROM THE(BUILDING
THE BUILDING EPARTMENT. DEPARTMENT.
X OWNER. X BY
i � /� 9�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
FOR OFFICIAL USE ONLY; Accepted by Date:
XXXXXXXX
ReceiptIa. Referred To
DEPARTMENTAL REVIEW Proposal Proposal
FOR OFFICIAL USE ONLY Approved Denied
Planning:
Building: as7z� .. � � 1 Ube <�
Fire Marshal: