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MASON COUNTY FIRE MARSHAL
_ Mason County Bldg. III 426 W Cedar St
PO BOX 186 Shelton,WA 98584
(360)427-9670 E#.273
Permit #k� I Y )(P
Mason County Fire Protection System Permit Application
/ Incomplete application will not he accented
Owner: "lovtQ� JJ,, Phone #: ��y�-`(�-t7
Mailing Address: r� City: (��� >� State:t4-Zip: WS%
Site Address: Sl7l JE A&4L< tj City 6U&t'&4-State:1 - Zip: 9Cr(;%
Parcel #: Legal Description:,?- r 6T r( LA 7- �47 c6l
Lien/Title Holder: Ab- —
t
Address: ))IA- City: State: Zip:
Contractor:
QU 5e,� & Z t Phone #: ma-1477- 6D
Address: // City: State:&Zip:
Contractor Registration #: 945:5 " gSr Expiration Date:
Building Square Footage (existing & proposed): 1. OW /ynv 2rd 3`d _. /
Building Use:5WAW `F C'An Occupancy Classification: �Construction Type: VB
Type of System: Type of Work:
Sprinkler: Wet Dry New System:
Standpipe: Wet_Dry Modification:
AFA:
Hood & Duct: _
Dry Chem:
Wet Chem:
Fire Pump: ,,fr� c �
UL certified Monitoring company: Phone #:M-� ,� L
3 / /
eprt�
Contractors Bid Price: $ �
