HomeMy WebLinkAboutMIS93-0049 - MIS Permit / Conditions - 3/4/1993 -v
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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 by date by
PLUMBING OTHER
Attic
Groundwork date by
date f by WALLBOARD NAILING
D.W.V. date by
date by Water Line FINAL INSPECTION
date by date by date by
I
_ Permit No.ON COUNTY . . L
PLUMBING/MECHANICAL PERMIT APPLICATION
PLEASE PRINT
i
#1 Owner 'c,CD R f- r °i/ r lyrc-�, _Phone# _ 4 2( r ,
Site Address / "/ �,D
City ; n N St
Directions to Job Site
7d
Owner Mailing Address W8 Dofvl
Cit Sty/,4
Lien/Title Holder_l�fONe.
Address
City St Zip
#2 Contractor Name e o b Contractor Reg# Od - C-//DG /Y
Address 20 ' X Expiration date
City_ hecro iy St4,-4Zip ?8Tc64 Phone 426- /466
1 y�� �S- Parcel—No.to l N W Y4- lV � `� 1�l E %4 5-20-
qDARcer 4200f3 -77- nc�0 �o
#4 Use of building �vCJ C Af ,4&e- Describe wor- --'
_ w M
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#5 Type of Job: New-X. Add Alt Repair
Plumbing Fixtures Fee No. Fee
No. d Toilets Vent Systems (Central)
! Bath Basins ' Vent Fans (S�ot/WHole)
Bath Tubs Boilers/Compressors
_Showers HP .00
_LHot Water Htr Air Handling Unit
Laundry Washer cfm
r Sinks Protection System
Floor Drains
Laundry Basins ,Fire
Dishwasher
Disposal
Urinals Other
Other
Permit Basic Fee . 00 Gas Outlets/hookups
Wood/gas/pellet Stove
TOTAL PLUMBING $ Other
Permit Basic Fee .00
Mechanical Fixtures TOTAL MECHANICAL $
No. Fuel Types
Furn . 00
Heat Pumps . 00
If this permit application includes the placement of a fuel tank, a site plan,
indicating lot dimensions, existing structures, structure setbacks, septic
systems, and easements MUST be attached.
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 ANYTIME AFTER WORK IS COMMENCED
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR
CONTRACTORS REGISTRATION LAW RCW 18.27 , AND AM AWARE IN THE STATE OF WASHINGTON AND I AM AWARE OF THE
OF THE MASON COUNTY ORDINANCE REQUIREMENTS FOR WHICH ORDINANCE REQUIREMENTS REGULATING THE WORK FOR WHICH
THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE
WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING
DEPARTMENT. DEPARTMENT.
X OWNER ' r 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 g5E ONLY: ! Accepted by
} t e
Approved Cond Hold
DEPARTMENTAL REVIEW - for office use only Approval
Planning:
Building Plan Review:
Occupancy Group:
Fire Marshal:
FEES
Special Conditions: Plumbing Fee
Mechanical Fee
Other
TOTAL
Valuation: