HomeMy WebLinkAboutMIS93-0193 Gas - MIS Permit / Conditions - 5/24/1993 MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
14IS9-3-0193 PAttt I I
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CONCRETE MECHANICAL MOBILE HOME
Footings-Setback date (0-L G by`4 n I; 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
Groundwork Attic
date by date by
D.W.V. WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTION _
date by date _C by date by
MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
I I
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 Final
Floors
date by date by date by
FRAMING Walls FIRE DEPT.
date by date by date by
PLUMBING OTHER
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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Permit
MASON COUNTY
PLUMBING/MECHANICAL PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584. 427-9670
PLEASE PRINT Q \
#1 Owner I kC�Aar Llfl c 5c_�Vlr_ Phone# 41Jv-_7'11( (home) 6-4,4 7( � )
Site Address _E f(o( rj 17,E
City J h2.sA-yn t4-St IW4- Zip `?6'15-fq
Directions to Job Site One j2e 5-� i `h r - - V• r` G.k
;u�lU STrti Nt4 ��a C� •��..- - :� 1�s�t �
Owner Mailing Address -Xt,M& G'5 c:bejs-
City St Zip
Lien/Title Holder
Address
City St Zip
#2 Contractor Name -6', r` 010b S Contractor Reg. #
Address Expiration date
City St Zip Phone
#3 Parcel No. 9 Zo - �-
Legal Description Se r i
#4 Use of building S 1 rU Describe work
#5 Type of Job: New Add Alt Repair
Plumbing Fixtures ($3 each EPg Mechanical Fixtures ($6 each)
No. Toilets CIRCLE FUEL TYPE: Gas, Electric,
_Bath Basins Heatpump, Other
_Bath Tubs No. UnkE
Showers Furn C BTU (o
Heatpumps
_Laundry Washer _ Vent Systems
_Sinks _ Spot Vent Fans
_Floor Drains No. Boilers/Comlressors
_Laundry Basins _ HP
_Dishwasher No. Air Handling Units
_Disposal cfm#
_Urinals No. Other
_Other Gas Outlets
_ Wood, Gas, Pellet Stove
Permit Basic Fee 15.00 -
TOTAL PLUMBING
� k ry
Permit Basic Fee tfw7 � 15.00
TOTAL MECHANICAL $
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
AWARE OFTHE MASON COUNTY ORDINANCE 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 WITHOUT 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
FOR OFFICIAL USE ONLY: Accepted by: Date:
Receipt No. Referred To
DEPARTMENTAL REVIEW Proposal Proposal
FOR OFFICIAL USE ONLY Approved Denied
Planning: A
Building:��� �
Fire Marshal: