HomeMy WebLinkAboutMIS95-0020 - MIS Permit / Conditions - 1/12/1995 77
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CONCRETE MECHANICAL MOBILE HOME
Footings-Setback date ' gf by Ribbons
date by Gas Piping date b
Foundation Walls date by Set Up
date by BG/SLAB Insulation INSULATION date by
Floors Final
date by date by date by
FRAMING Walls FIRE DEPT.
date by PLUMBING date by OTHER date by
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 4# 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 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
I
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Permit No.
MASON COUNTY
PLUMBING/MECHANICAL PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98, 4. 427-9670
PLEASE PRINT
#1 Owner Phone
Site Add ss
City 1�'`6 St Zip
Directi s to Job Site ,
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1
,
Owner Mailing ddress
City St Zip
Lien/Title Holder
Address
City ,
St Zip
Re . #
#2 Contractor Name0140111Contractor g
Address
Expiration date
City St Zi Phone
#3 Parcel No.
Legal Description (,�✓�1.�
#4 Use of building aS _ Describe work
#5 Type of Job: New Add Alt ✓Repair
Plumbing Fixtures ($3 eachl Fee Mechsjnical Fixtures ($6 each)
No._Toilets CIRCLE. FUEL TYPE: Ga , lectric,
_Bath Basins Heatp01mp, 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 t
Wood Gas, Pellet Stove 25.00
Permit Basic Fee 15.00
TOTAL PLUMBING $
Permit Basic Fee
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 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 CONTRAC-
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 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 MADEWITHOUT 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
FFOROFFICIAL USE ONLY: ,4ccepted by: atipt No. Referred To
DEPARTMENTAL REVIEW
FOR OFFICIAL USE ONLY Proposal Proposal
Approved Denied
Planning:
Building:
Fire Marshal: