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Inspection Line(360)427-7262
MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670,ext.352
Mason County Bldg. 3 426 W. Cedar P.U. Box 186
Shelton,WA 98584
PLUMBING PERMIT BLD2009-06864
OWNER: LAWRENCE, FISCHER RECEIVED: 10/2/2009
CONTRACTOR: LICENSE: EXP: ISSUED: 10/2/2009
SITE ADDRESS: 3890 E STATE ROUTE 302 BELFAIR EXPIRES: 4/2/2010
PARCEL NUMBER: 122213100090
LEGAL DESCRIPTION: TR 9 OF GOVT LOT 3 &TAX 1315-B & 12X-2 SEE SURVEY 10/125
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
TOILET, SINK, WATER HEATER 38.9 MILES FROM ALLYN FIRE STATION FOLLOWING AROUND END OF
NORTH BAY ON HWY 302, ORANGE MAIL BOX.
General Information Plumbing Fixtures FEES
Type of Use: SF Insp. Area: Type Qty. Type By Date Amount Receipt
Type of Work: ACC Fire Dist.: 2 Lavatories Plumbing Permit Fee TIN 1nrgr9nnci �,?r;in gtgnnar
Water Closets (Toilets) Plumbing Base Fee TIA/ inrgrgnnQ T,9a 7n -,t9nnor
Water Heaters 1 Total $50.80
BLD2009-00864 Please refer to the following pages for conditions of this permit. 1 of 2
CASE NOTES FOR
BLD2009-00864
CONDITIONS FOR
BLD2009-00864
1) Contractor registration laws are governed under RCW 18.27 and enforced by the WA State Dept of Labor and Industries, Contractor Compliance
Division. There are potential risks and monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at
1-800-617-0982. The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law.
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2) Owned/Agent is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28.
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3) All building permits shall have a final inspection performed and approved by the Mason County Building Department prior to permit expiration. The failure
to request a final inspection or to obtain approval will be documented in the legal property records on file with Mason County as being non-compliant with
Mason County ordinances and building regulations.
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This permit becomes null and void if work orconstruction authorized is not commenced within 180 days,or if construction or work is suspended for a period of 180 days at any time after work is
commenced. Evidence of continuation of work is a progress inspection within the 180 day period. Final inspection must be approved before building can be occupied. Proof of continuation of
work is by means of a progress inspection.The owner or the agent on the owners behalf,represents that the information provided is accurate and grants employees of Mason County access to
the above described property and structure for review and inspection.
OWNER OR AGENT: c icJ DATE: D ZI-2_001
BLD2009-00864 Please referto the following pages for conditions of this permit. 2 of 2
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f PERMIT NO.
MASON COUNTY
PLUMBING/MECHANICAL PERMIT APPLICATION
426 W. Cedar• P.O. Box 186, Shelton, WA 98584
Shelton (360) 427-9670• Belfair(360) 275-4467• Elma (360)482-5269
On the web www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR I"M TION
Owner ! F/' P 4 ,`— i>� i����� Company Name �� '�
Mailing Address ,L 42, .42,6!/ 1,26!f Mailing Address
city l���� ��� State bll Zip Code City State Zip Code
Phone ' Other Plh kO 5�'S�G Phone Other Ph.
Lien/Title Holder Contractor Reg. # Exp.
E mail address ��s �r✓ `�� ��� h�"t'vyr�k nc>•yt E Mail Address
Drivers Lic.#F C IVLL "" DOB VI ',;, Drivers Lic. # DOB
SEPTIC INFORMATION - Connect to New Septic Existing Septic. Connect to Sewer System
Name of Sewer System v le-_ i4
PARCEL INFORMATION - 12 Digit Parcel N Fire District �—
Legal Description 7-12 > 6-A 6e ti�r 3 ifT�� f3i a-L3 /�h'-2 5� S�l/�✓ l` l�ja s-
Site Address (Pleas include street name, street number and city) 3 f� i 52 3o;L
Directions to site Al %-� � 4yrN eAZ /L, cam. l,�Y,re� . l e Al�: ,N� 3oa7 r�
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Is property within 200' of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff _Stream Slopes or Bluffs > 15%
TYPE OF JOB - New Add Alt Repair Other(e,4ec�r/o,&Use of Buildiineg �
Location of Fixtures/Units - 1st FlooL 2nd Floor baser r'{"4 ` a AI ra�e'_ -)at Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS
Type of Fixture No. of Fixtures Fees Fuel Type:Electric_LPG Natural Gas Heat Pump_
Toilets / Type of Unit No. of Units Fees
Bathroom Sink Furnace
Bath Tubs Heatpumps
Showers _. Spot Vent Fan
Water Heater Propane Tank
Clothes Washer Gas Outlets
Kithen Sinks Wood/Gas/Pellet Stove
Dishwasher Kitchen Exhaust Hood
Hosebibs Dryer Vent
Other Other
Base Fee Base Fee
TOTAL PLUMBIN TOTAL MECHANICAL
OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of
such is by signature below. I declare that I am the owner,owners legal representative,or the contractor. I further declare that I am entitled to receive this
permit and to do the work as proposed in the application. 1 declare that I have obtained the permission from all the necessary parties. If permission is
required from any easement holder or any other parry in interest regarding this application or the work proposed in the application, I have obtained
permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf, represents that the information
provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection.
PROOF-Or CONTINUATION OF-WO13K I Y MEANS OF A PROGRESS INSPECTION.
X -� Date: r/
Owner/Owners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by: Planning Pd _Ck# Date Bld Pd Receipt No.----
DEPARTMENTAL REVIEW I APPROVED DENIED NOTES
Building Department W
Occ Group—Type Constr.
Planning Department
Environmental Health Department
FEES
Plumbing & Base Fee Site Inspection
Mechanical & Base fee UFC Plan Review Fee
Wood/Gas/ Pellet Stove Fee Other
Violation Fee TOTAL FEES