HomeMy WebLinkAboutMIS93-00555 Furnace, Gas Piping and Duct Work - MIS Permit / Conditions - 9/16/1993 MASON COUNTY PERMIT
Mason County Bldg. III 426 W. Cedar NUL V ID BY EXPIRATION
P.O. Box 186 Shelton, Washington 98584 DATE BY
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MASON COUNTY
Mason County Bldg. 111 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
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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
Groundwork Attic
date by date by
D.W.V. WALLBOARD NAILING
date by date by i
Water Line FINAL INSPECTION
date by date by date by
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Permit No. I '—
MASON COUNTY �Js
PLUMBING/MECHANICAL PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584. 427-9670
PLEASE PRINT
#1 Owner C. h uo l f s Y✓1 c,r , IA t I I Phone
Site Address / .J -I I i oo,tilA III L 1.r � c
City St w A. Zip
Directions to Job Site old ax ��w,� �o� w�u to ,��ry �z._e �EL,�dT0 -
7%o.irj',1 0. I1F P_ .
Owner Mailing Address
City St Zip
Lien/Title Holder
Address
City St Zip
#2 Contractor Name /V0k PA, Contractor Reg. #rl 0K P/4/4A f a 3Nts�
Address 3 V1 -/ / Expiration date
City St IAI Zip SSOD _-R Phone
#3 Parcel No.,Q;--) 3 1 i
Legal Description A a i;
#4 Use of building s s t ,vim f Describe work
�, IAl e-� /7OT Ls)c.�r �� � . �^��Y oQei .� �Arcrr � •
#5 Type of Job: Newer Add Alt Repair
Plumbing Fixtures ($3 each) F_eg Mechanical Fixtures ($6 eachl
No._Toilets CIRCLE FUEL TYPE: Gas, Electric,
_Bath Basins Heatpump, Other f
_Bath Tubs No. Units
_Showers I Furn '-'3/ 1 o- 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 Gas Outlets
_ Wood, Gas, Pellet Stove
Permit Basic Fee 15.00 pr"." Ta'L'
TOTAL PLUMBING $ _
Permit Basic Fee 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.
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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 Lines, Septic Systems,
Flood Zones, Wells, Shorelines, Easements, Name of Flanking & Fronting Streets. Indicate directional by N, S, E, W, etc.
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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 WITHOUT FIRST OBTAINING APPROVAL FROM WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING
THE BUILDING DEPARTMENT. DEPARTMENT.
X OWNER X BY
DATE DATE 7//6�`1.3
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:
Building:
Fire Marshal:
I