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( o CONCRETE MECHANICAL MANUFACTURED HOME _ o Date By r Footings !Setbacks Ribbons Gas Piping C, Intenor Date By Interior- Date By Data By Z Exterior Date By Exterior-Date By Set-up - - r p Point Load!Isolated Footings ings Date By 0 Date By Data80 1 SLAB INSULATION By FIRE DEPARTMENT Z Foundation Walls Floors Date By Date By Data _ By DECKS FRAMING Walls Date By Date By Dale By PROPANE TANKS PLUMBING Vann Date By Date By OTHER Groundwork Attic Date By Date By Type. Date By O.W.v DRYWALL Type Int.Brea wan Dale By W Date By Date By FINAL INSPECTION O m Water Line Firs Seperstion / N m' Dale By Date By Date rD By GX Co s Pass or Request Inspect. c Type of Insp. Fall Date Date Done By Comments N v iJ A-1__ 10 I L m m ar w 0 n 0 m o_ s w' N <0 lD O r. .A eo" co, UNZA MASON COUNTY PERMIT NO. 51 � Z&Ik - Cf c/Z ' DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING• PLANNING• FIRE MARSHAL WWW.CO.MASON.WA.US (360)427-9670 Shelton ext.35�ECEIVED Mason County Bldg. III, 426 West Cedar Street (360)275-4467 Belfair ext. 35 1854 PO Box 279, Shelton, WA 98584 (360)482-5269 Elma ext.352 5EP 16 1U16 PLUMBING & MECHANICAL PERMIT APPLICATION 615 W. Alder Street OWNER INFORMATION: CONTRACTOR INFORMATION: NAME: Le-,c_vs-� C_"Aisoo NAME: Le_q x. ot�xr (QMVVk11( MAILING ADDRESS: t"!p ►` MAILING AD RES : !'3a ZcQ CITY'' STATE: �p ZIP:G � CITY: rk STATE:I�aA ZIP. $3 Z PHONE: _M1 ELL: PHONE:Za3 OW4CELL: EMAIL: EMAIL : r I o ov3e1- . L&I REG# AP. ,-5 10 -n PARCEL INFORMATION: PARCEL NUMBER(12 DIGIT NUMBER): LEGAL DESCRIPTION(ABBREVIATED): SITE ADDRESS: J -Tco lll---E- rJ c^ CITY: y%�- DIRECTIONS TO SITE ADDRESS: w l W TYPE OF JOB NEW_Jk, ADD ALT REPAIR OTHER USE OF BUILDING LOCATION OF FIXTURES/UNITS— 1ST FLOOR 2ND FLOOR BASEMENT GARAGE OTHER PLUMBING FIXTURES(SHOW NUMBER OF EACH) MECHANICAL UNITS Type of Fixture No. of Fixtures Fees Fuel Type:Electric I LPG Natural Gas Heat Pump_ Toilets Type of Unit No.of Units Fees Bathroom Sink Furnace Bath Tubs Heatpump Showers Spot Vent Fan Water Heater Propane Tank _ 5173 ov Clothes Washer Gas Outlets „-� G 20 Kitchen Sinks Wood/Gas/Pellet Stove Dishwasher Kitchen Exhaust Hood Hosebibs Dryer Vent Other Other Base Fee Base Fee 1 TOTAL PLUMBING TOTAL MECHANICAL 1790 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 contractor. I further declare that I am entitled to receive this permit and to do the work as proposed. I have obtained permission from all the necessary parties, including any easement holder or parties of interest regarding this project.The owner or authorized agent represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure(s)for review and inspection.This permit/application becomes null&void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OF INSPECTION.INACTIVITY OF THIS 7XP CATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. gnature ppkea� Date X Owner/Owners Representative/Contractor Print Name (indicate which one) DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT FIRE MARSHAL