HomeMy WebLinkAboutMIS97-00673 Cancelled Propane, Hot Water Heater and Furnace - MIS Application - 10/14/1997 Permit No.
MASON COUNTY
PLUMBING/MECHANICAL PERMIT APPLICATION ,,,,, _',�A'��
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 • 427-9670
PLEASE PRINT
#1 Owner ndf L-) n� Dl Phone #
Site Address 3D 4 L
City St Zipj, �'
Directions to Job SiteDY c 'in
VL- I 'e � I / a
11t D e! "'l (" hy
Owner Mailing Address Q197 WVC41
City en St W Zip 92312
Lien/Title Holder WA ML"he'a
Address -k U
City 2(En)el-to'7 St Zip
#2 Contractor Name N Alb . cla Contractor Reg. #
Address Expiration date
City St Zip Phone
#3 Parcel No. 223'D( - 5 - 02
Legal Description 01 Sut.re
#4 Use of building Describe work
#5 Type of Job: New Add V Alt Repair
Plumbing Fixtures ($3.35 each Fee Mechanical Fixtures ($6.75 each)
No._Toilets CIRCLE FUEL TYPE: Gas, Electric,
_Bath Basins Heatpump, Other
Bath Tubs No. Units Fees
Showers Fu rn BTU
J_Hot Water Htr .35 — 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 33.00
A n L
TOTAL PLUMBING
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 180 days at a
time after work is commenced. Proof of continuation of work is by means of a oroaress inspect,
r
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 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 DEPARTMENT DEPARTMENT.
X OWNER �. kL X BY
DATE &OC-( q .--? DATE
Return permit to: Department of General Services
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 . 427-9670/1-800-562-5628 _
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.dui�J�1=iCIAL USI bt�tLY;fAccepted�Y Date �� �f �e
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eCeZpt Na E Q � a F a Ref+arred'T .
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DEPARTMENTAL REVIEW Proposal Proposal
FOR OFFICIAL USE ONLY Approved Denied
Planning:
Building:
Fire Marshal:
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