HomeMy WebLinkAboutMIS95-0046 - MIS Permit / Conditions - 1/23/1995 71
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BG/SLAB Insulation
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date b Floors Final
FRAMING y date by date by
date b Walls FIRE DEPT.
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Groundwork Attic OTHER
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D.W.V. WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTION
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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 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
i date by date by
Water Line FINAL INSPECTION
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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 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
Permit No.
10 MASON COUNTY l
PLUMBING/MECHANICAL PERK41T APPLICATION �0�"'
426 W. Cedar/P.O. Box 186, Shelton, WA 98584. 427-9670 � ��
PLEASE PRINT C
#1 Owner ' r✓ R&tE% / — Phone # _210 - S_ ycs-
Site Address / 14L %=(Z ' /V to _ IV
City 451 L 1_ i Z St-WA zip
Directions to Job Site DA rO 7—PA 1 4-S - -S✓I(L'�
Owner Mailing Address / / I-IEll
City 51� �'% St_ VIZ40 Zip �J �S
Lien/Title Holder JL/0/(j/-_
Address
City St_ Zip
#2 Contractor Name Contractor Reg. #
Address Expiration date
City St Zi _ Phone
#3 Parcel No. L cQcoC� q(-)
Legal Description
#4 Use of building Describe work
#5 Type of Job: New_t,,,�Add Alt Repair
Plumbing Fixtures ($3 each) Fee Mecha ical Fixtures 6 each
No._Toilets CIRCL FUEL TYPE: Gas, Electric,
_Bath Basins HeatpL mp, 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 i HP
_Dishwasher No. Air Handlin Units
_Disposal cfm#
Urinals No. Other
_Other Gas Outlets
Wood, Gas, Pellet Stove 25.00
Permit Basic Fee 15.00 5! ZROAJ
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 s 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
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 OUTFIRSTOBTAI APPROVALFROM WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING
THE BUiLDIN ARTMEN j DEPARTMENT.
X OWN 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
FOR OFFICIAL USE ONLY: Accepted by:
Receipt Na. Referred To
DEPARTMENTAL REVIEW Proposal Proposal
FOR OFFICIAL USE ONLY Approved Denied
Planning:
Building: - (.� ��B� -✓fl
/ 1 r
Fire Marshal: