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Home My WebLink AboutMIS93-0574 Cancelled Propane - MIS Permit / Conditions - 10/23/1997 MASON COUNTY PERMIT Mason County Bldg. 111 426 W. Cedar NULL VOID 13 EX At1011� P.O. Box 186 Shelton, Washington 98584 DATE BY t (A Hi f-H WY J )tMIYA I 10 "i t' '�'}i I ti I J0#4H 11 �,Kf- I I ON 7 41, It; H 1 .......... t ROM SHVI I ON IAKt' HWY 4 NOR M JWOARDl -, [JV 1.1-Al R I AKf A I f I- I IiN I o 11WV i0o Wt i 110 10- NOR I H`i"ClRf�. RD I AK R I G H I A-( II F I VA I R I AMPYA 111) 141 N 14AVi N WAY A I I lit IfAVI- 0 1 A1(1. 404 1 Ai< ) ROA0 1 4'1N0',%!-, 11AV(- N WAY !"j OoO vu i Vp 0 1 *4 #1 4,1101V I i AM i- 1 0 A I I AU fit P I omi) I I I 1)4 Rf-01)1 RF 1) CONCRETE MECHANICAL MOBILE HOME Footings-Setback date by Ribbons date by Gas Piping date b Foundatidn 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 b date by D.W.V. WALLBOARD NAILING date by date by Water Line FINAL INSPECTION date by date by date by MASON COUNTY Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 i i ----_. MASON COUNTY Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 EMPIREGAS SERVICE AND INSTALLATION REPORT y �1�7 �S � P�n�- Date of Call: �y�12'-�� Time: �� :�rJ Company Name5ke CTO►N Company 1! Customer 11 Customer Route !1 Customer Phone 11 �� 2? 7 8 Name of Person Calling: T(06 5AC L7 OY1 Address N C /Wo aVen w oy LkuyeI W Iq 1 5"?? Directions: Special Instructions DESCRIPTION OF MATERIALS I D - fzfma pit Se v �� hi�u d A OCT �9 3 Materials Z z 7� was Sniff Test Performed with Customer? Yes_No Was System Operation Explained to Customer? Yes_No_ Does Tank Need to be Painted? yes_No Labor Ears. + @ Tax TANK AND EQUIPMENT SERVICED �Q !, Tank Size Zv Scrial + �� O400v Refer to Ti ke. s� s/ Cas in Tank 7 Total For Billing or Collection Tank Set ❑ Tank Pick UP ❑ Otscunnect 0 Range Water no:,t, r ❑ System Leak Check f Zo Ih b O O Furnar�• ki Space Ileater ❑ Reseller ❑ Lbs. or W.C. Time Pump Make Srriai Checked Appliance Vent Yes No + _ Meter Make '� yi.,•; ,1 , Gas Check Performed Yes No )✓ Pressure - 1st Stage 2nd Stage Work Performed: Moak 7�nA _. Comments: q(Ad 7-6 MQQo LAMA. !'r LOOSE � / T YGh'� &J/Ld, R, . A10Sc,n Couvq� Ube UFC, ft in Plate q IUFpH s- Customer Signature Date Serviceman Signature WHITE - OFFICE COPY - RETAIN UNTIL WORK IS COMPLETED AND BILLED NOT A RECEIPT YELLOW - SERVICEMAN'S COPY - ATTACH TO OFFICE COPY OF BILLING PINK - CUSTOMER COPY Permit Nb"C is 93 MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATION 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 • 427-9670 PLEASE11RINT #1 Owner �o�" v� 5 K,,/4.7Phone#�,-7°r' ) 2 '2S-?8 t79 Site Address /SpcNciu« GUc4Z City 4 y a Z-,L) / St zip c Directions to Job Site SL"' —1 w s Y Owner Mailing Address Q 14-1 City St Zip Lien/Title Holder Address City St Zip #2 Contractor Name�'� a �',.e S Contractor Reg. # Address Expiration date City E V CAM,R Azinhr, St LA(&Zip I Z Phone #3 Parcel No. 2 2 3 a - Legal Description 444___� L ��( � L L+ #4 Use of building ;:�✓b ► .-- `�1 Describe work #5 Type of Job: New Add Alt Repair Plumbing Fixtures ($3 each) Fee Mechanical Fixtures ($6 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 Gas Outlets Wood, Gas, Pellet Stove Permit Basic Fee 15.00 .`TT,(L (o dp TOTAL PLUMBING $ _ Permit Basic Fee 15.00 TOTAL MECHANICAL $mil 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. I � 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. a c_--o s 4 14L, at 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 ISSU ED AND ALLWORK DONE WILL BE IN DONE WILL BE IN CONFORMANCE THEREWITH.NO CHANGES CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE SHALL BE MADE WITHOUT FIRSTMTAINJPGAPPROVALFROM WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING THE BUILDING D A TMENT. DEPARTMENT. X OWNER X BY DATE C�e 2 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 Proposal Proposal FOR OFFICIAL USE ONLY Approved Denied Planning: Building: Fire Marshal: