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HomeMy WebLinkAboutBLD0851 Plumbing/Mechanical - BLD Application - 4/18/1996 Permit No. MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATION PLEASE PRINT 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 • 427-9670 -16�8/� /' #1 Owner L41AI-7-C ' S, (_©GD/,Pon/ Phone# Site AddressiVE City St In14. Zip Directions to Job Site 1,1/G/I S .601-Si S/DE IIV,4So v/C T�6021— Owner Mailing Address )0,p, .5"4/3 City Z3ELFA/0 St J, w' Zip 9V-672 r Lien/Title Holder A-1-4 y g, 1V& Address City �EL'<41' St Lc%, Zip 9'F-5�Z F #2 Contractor Name -W �- y icC� Contractor Reg. # A-C-e I S / o cc me Address (�J O Expiration date City St Zip Z-g Phone #3 Parcel No. 000 1 O Legal Description ; a 15 14 22 ZS 5���} JR.q #4 Use of building Describe work #5 Type of Job: New Add Alt Repair Plumbing Fixtures ($3.25 each) Fee )Mechanical Fixtures ($6.50 each) No._Toilets CIRCLE FUEL TYPE: Gas, Electric, _Bath Basins Heatpump, 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 I Gas Outlets o Wood, Gas, Pellet Stove 32.00 Permit Basic Fee 16.25 TOTAL PLUMBING $ _ Permit Basic Fee 16.25 TOTAL MECHANICAL $ 5�5- 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,locate, 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. E �Y_ 3 v s�ai r U G R� 5 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 SHALLBE MADE WITHOUT FIRSTOBTAINING APPROVAL FROM WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING THE BUILDING D PARTMENT. ,��/ 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 USEONLY: Accepted by:.. Date: ` • Receipt No. Referred To DEPARTMENTAL REVIEW Proposal Proposal FOR OFFICIAL USE ONLY Approved Denied Planning: Building: Fire Marshal: