HomeMy WebLinkAboutMIS94-00584 Plumbing - MIS Permit / Conditions - 8/31/1994 MASON COUNTY
LO g Mason County Bldg. III 426 W. Cedar
RO. 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 b
D.W.V. WALLBOARD NAILING
date _ /I by L J date by
Water Line FINAL INSPECTION
date by date by date by
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MASON COUNTY
Mason County Bldg. III 426 W. Cedar
F.O. Box 186 Shelton, Washington 98584
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Permit No.
MASON COUNTY
PLUMBING/MECHANICAL PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584. 427-9670
PLEASE PRINT
#1 Owner rr A !�_ < Phone# a75- .-F 7 2.
Site Address Z� I /tij/ S S/oAl� K, D-
city�SGL F"A/R St zip
Directions to Job Site �'gym; L.t v �I I '�/n r,/ Q_R r=C,4 K o A�2 O A- L E-
- EAL
Owner Mailing Address
city HG1.FA I B St Zip ` ' S"2 R
Lien/Title Holder
Address
City St Zip
#2 Contractor Name Contractor Reg. #
Address Expiration date
City C-�aS,5 - 51) -6LIj2l�)'5 St Zip Phone
#3 Parcel No.,
Legal Description v Y- 3
#4 Use of building - Describe work L E M n n''e_
ILL 4 M r7-t2/,E ,U fib a i S',C -6- S'o e Ti C.
#5 Type of Job: New Add Alt Repair
Plumbing Fixtures ($3 each) Fee Mechanical Fixtures ($6 each)
No. { Toilets CIRCLE FUEL TYPE: Gas, Electric,
1 Bath Basins Heatpump, Other
Bath Tubs No. Unk Fees
_LShowers _ 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 16, C Gas Outlets
Wood, Gas, Pellet Stove 25.00
Permit Basic Fee 15.00
TOTAL PLUMBING $ C _
Permit Basic Fee 15.00
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 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 System*
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
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
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
FOR OFFICIAL USE ONLY Proposal Proposal
Approved Denied
Planning:
Building:
Fire Marshal:
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