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W w y 'O_ S N A (» fn m Omm mm m . w go3a � ~, m 'm o w m _° J <» m ° m yt;0m3 Qm m _. c 3 J = a c w 3 CD p N CD rW o CONCRETE Gas piping �+ MANUFACTURED HOME C o Interior-Date By w Footings I Setbacks Fxtenor-Date By Ribbons aData INSULATION Date BY co Foundation Walls BG 1 SLAB INSULATION Set-up Date By Date By Date By = O FRAMING Floors FIRE DEPARTMENT D Da to By N Date By WallPate By PLUMBING Da to By DECKS m ------ Da to By Groundwork Vault Date BY TANKS Date By Attic Date By D.W.V Date By OTHER Date By DRYWALL Type Date By Water Line Date By Type: v Date By Int.Brace Wall Date By W MECHANICAL Dale FINAL INSPECTION o Fire Separation Date By Date By Date .,Z©— By72—�- t j s Pass or Request Inspect. o Type of insp. Fail Date Date Done By Comments A o c0 a m m m 0 0 0 0 0 0 m a m 3 m 0 I l MASON COUNTY PERMIT NO. 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 ORATION + Owner ,..._�1�w}/� rt /L�� '`� Company Name , Mailing A res '� �s Mailing Address City St to A Zip Code City State Zip Code Phone` ' O e Fh. Phone Other Ph. Lien/Title Holder ' ' �� r dr'F'�` Contractor Reg. # Exp. E mail address E Mail Address f Qe.# �IIS SEPTIC INFORMATION - Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION- 12 Digit Parcel No. Fire District Legal Description Site Address(Please include street name,street number and city) Di ections to site ,�cc� ✓ %f� 7 t+' C LU �C ? lam/ � it ` 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 Use of Building Location of Fixtures/Units- 1st Floor 2nd Floor Basement Garage 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/PelletStove K� Dishwasher Kitchen Exhaust Hood Hosebibs Dryer Vent Other Other Base Fee Base Fee TOTAL PLUMBING 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.I declare that I have obtained the permission from all the necessary parties.If permission is required from any easement holder or any other party in interest regarding this application or the work proposed in the application,I have obtained permission from th apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information provided is a is employees of Mason County access to the above described property and structure for review and inspection.W�OOF O OF R BY MEANS OF A PROGRESS INSPECTION. Date: ✓� Owner/Owners Repre tative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Planning Pd Ck# Date Bld Pd Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department 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