HomeMy WebLinkAboutBLD2019-00184 Plumbing TPN42001-44-90001 - BLD Application - 2/28/2019 MASON COUNTY COMMUNITY SERVICES PermitNo`kA,;���
PERMIT ASSISTANCE CENTER: RECEIVED
•BUILDING •PLANNING •FIRE MARSHAL
615 W.Alder St-Shelton, WA 98584
www.co.mason.wa.us VIAR 0 1 2019
Phone Shelton:(360)427-9670 ext. 352• Fax:(360)427-7798
Phone Belfair. (360)275-4467• Phone Elma:(360)482-5269 615 W. Alder Street
PLUMBING & MECHANICAL PERMIT APPLICATION
OWNER
OWNER INFORMATION: e'e yJ CONTRACTOR INFORMATION:
NAME: NAME: a r v 4 c cf-
MAILING ADDRESS: /4'd 1✓ 7� ,•t - Y j MAILING ADDRESS. ; p 0 7 7,2,A'; . q LIF
CITY: 1, STATE: ZIP: � > ';'`( CITY:C •stP <<.l r'STATE: le ZIP f*
I"PHONE: 3 Pc - :• , — 4 PHONE ,i'r''- V-7 7` CELL:30-;a
2nd PHONE: EMAIL ,r:5.:_ :" o r
EMAIL: L&I REG# EXP.
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number): - y -Gl�ooi Zoning:
LEGAL DESCRIPTION(Abbreviated):
SITE ADDRESS: y , ; CITY:
DIRECTIONS TO SITE ADDRESS:
TYPE OF JOB:
NEW ADD ALT REPAIR OTHER USE OF BUILDING
LOCATION OF FIXTURES/UNITS—1 sT FLOOR >< 2ND FLOOR BASEMENT GARAGE-OTHER-
PLUMBING FIXTURES(SHOW NUMBER OF EACH) MECHANICAL UNITS
Type of Fixture No.of Fixtures Fees Fuel Type:Electric LPG X Natural Gas Ductless_
Toilets Type of Unit No.of Units Fees
Bathroom Sink Furnace
Bath Tubs Heat Pump
Showers Spot Vent Fan
Water Heater Propane Tank
Clothes Washer Gas Outlets
—
Kitchen Sinks Wood/Gas/Pellet Stove
Dishwasher Kitchen Exhaust Hood
Hose bibs Dryer Vent
Other Solar Panel
Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
OWNER acknowledge 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 permittapplication 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 OFTHIS PERMIT IS BY MEANS OF INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS
WILL INVALIDATE THE APPLICATION.
X
Signature of OrW69r Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL