HomeMy WebLinkAboutMIS97-0641 Hood Exhaust - BLD Application - 9/25/1997 UV,ID/V1 nUN WJ:JS tAA Jl3U4Z777U4 14ASUN WILIMA BLU J 10002
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Permit No.
MASON COUNTY
PLUMBING/MECHANICAL PERMIT APPLICATION 41 a\
426 W. Cedar/P.O. Box 186, Shelton, WA 98584•427-9670
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Phone# -S6o,;Z
Site Address o n>; �� �L F'
City
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Directions to Job Site
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City i u I; St zip
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Lien/Title Holder
Address
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�02 Contractor Name ,-;e Contractor Reg. # 11 �/�%/7P 7
Address e ) C� l'c� Expiration date II&A6
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!t8 Parcel No. �clao
1 Legal Description
#4 Use of building Describe work
#5 ype of Job:New Add� Alt Repair
Plumbing EWures j$3.35 each) F Mechanical Fixtures ($6.75 ea
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No. Toilets CIRCLE FUEL TYPE: Gas, Electric,
Bath Basins Heatpump,Other
Bath Tubs No. Un its Fee&
Showers Furn f3TU'-
Hot Water Htr — Heatpumps / 7
_Laundry Washer 1 Vent Systems r r:
Sinks Spot Vent Fans
Floor Drains No. Boilers/Comor se sors_
rLaundry Basins — HP
Dishwasher No. Air Handlin i s /f
Disposal �—
Urinals No. Qiher
Other Gas Outlets
_ Wood, Gas, Pellet Stove 33.00
Permit Basic Fee 16.75 —
TOTAL PLUMBING $
Permit Basic Fee 16.75 <�
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 18o days at any
time after work is commenced. Proof of continuation of work Is by means of a nroaress inspection.
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' 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 Lanes, 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 OF THE MASON COUNTYORDINANCE REQUIREMENTS ORDINANCE REQUIREMENTS REGULATING THE WORK FOF
FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL WORK WHICH THE PERMIT IS ISSUED ANDALL WORK DONE WILL BE 1N
DONE WILL BE IN CONFORMANCE THEREWITH.NO CHANGES CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE
SHALLBE MADE WITHOUT FIRST OBTAINING APPROVAL FROM WITHOUT F ST OBTAINING APPROVAL FROM THE BUILDING
THE BUILDING DEPARTMENT. DEPAR N
X'OWNER X BY G
DATE DATE 11�j G►`�
Return permit to: Department of General Services
426 W. Cedar/P.O. Box 186, Shelton, WA 98564-- 427-9670/1-800-562-5628
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DEPARTMENTAL REVIEW
FOR OFFICIAL USE ONLY Proposal Proposal
Approved Dented
Planning: CL
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Building: (o L'r--
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Fire Marshal:
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