HomeMy WebLinkAboutBLD2005-00695 Cancelled Propane BLD2005-00696 Cancelled Insulate and Sheetrock - BLD Permit / Conditions r a 4
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FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NO.000 5'- 0 00q
PLEASE PRESS HARD
PLUMBING/MECHANICAL PERMIT APPLICATI
6
Shelton (360)427-267% Belfair(360)275-4467•Elma(360)482-5269
n t e web"MO)
APP ANl INFORMATION CONTRACTOR INFORMATION
Owner A 0—A-h� Company Name
MailingAddres Mailing Address
G[ O'tate Ul/��Zip Code City Mate Zip Code
CityPhone p O/—/5'00 Phone Other Ph.
Lien/Title Holder ""`'—� Contractor Reg.# Exp.
E mail address E Mail Address
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC INFORMATION - Conne to New Septic Existing Septic Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION- 12 Digit Parcel No. —' Fire District
Legal Description OAT -S 2�
Site Address (Please include street name, street number and city) -Z,-1,we i es
Direct' ns to site auk 02 2 0 /�
U/�lGeOc//'l Y
is property within 200,of Saltwater 4= Lake River/Creek Pond
Wetland—Seasonal Runoff—Stream—Slopes or Bluffs > 15%
I( TYPE OF JOB - New Add Alt Repair Other Use of Building
Location of Fixtures/Units- 1st Floor 2nd Floor,_ Basement Garage Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS
Pump—
Type o No. of Fixtures Fees Fuel Type:Electric.__ LPCa._ Natural Gas`_ Heat Pump_
Toilets one of Unit No.of Units Fees
Bathroom Sink Furnace
Bath Tubs Heatpumps
Showers Spot Vent Fan
Propane Tank
Water Heater Gas Outlets
Clothes Washer Wood/Gas/PelletStove 1
Kithen Sinks Kitchen Exhaust Hood
Dishwasher Dryer Vent
Hosebibs Other _----
Other - Base Fee
Base Fee TOTAL PLUMBING—] TOTAL MECHANICAL
O1MNER/BULDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledge ment 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 rawis
is
permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary par pe
or work in the application,I have obtained
j required from any easement holder or any other party in interest regarding d. The
owner or agent en o behalf,reresents that the information
permission from them to apply for this perm rt and conduct the work proposed. and structure for review and inspection.
provided is accurate and grants employees of Mason County access to the above described property
PROOF OF CONTINUATION WO BY MEANS OF A PROGRESS INSPECTION.Z �
Date: 12
X
Owner/Owners Representative/C or (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT Receipt No.
Accepted by: Planning Pd Ck# Date
IDEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department ✓ o 11-
Occ Grou Type Constr.
PlanningDepartment
Environmental Health Department
FEES
P
lumbing ase Fee Site Inspection
Base fee UFC Plan Review Fee
PelletStove FeeOther
TOTAL FEES
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D ate B y Date B y Date B y
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