HomeMy WebLinkAboutBLD2005-01952 - BLD Application - 10/11/2005 MASON COUNTY
COMMUNITY SERVICES pLA PL REVISION RECEIVED
Building,Planning,6wironmentalHealth,Community Health REC O�jT 217
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Physical and Mailing Address: 615 W Alder St., Bldg 8, Shelton, WA 98584 DATE
Shelton Phone: (360)427-9670 ext 352 ❖ Fax (360)427-7798 �� W Street
PLUMBING & MECHANICAL PERMIT APPLICATION Permit#: 1 ki U05 ( 15Z
OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: 'T ' G �+2• NAME:
MAILING ADDRESS: F.O- kct St 7 MAILING ADDRESS:
CITY: KI STATE:WA ZIP: '15524 CITY: STATE: ZIP:
1st PHONE: — % PHONE: CELL:
2nd PHONE: EMAIL :___________________________________
EMAIL: - vf'i ts.r c�� + �trdJ r+�c " L&I RE" EXP. / /
PARCEL INFORMATION:
PARCEL NUMBER (12 Digit Number): S2_2 Zoning:_____________
g
LEGAL DESCRIPTION (Abbreviated):
SITE ADDRESS: 4O J CITY: ( s2--PG_'
DIRECTIONS TO SITE ADDRESS: ' Vi n- FZTbL' . L f2f1
l 2,r i c, ç - 4-'-- 2-v\ i a,L")�ry O . C_r= - P,- t-- O pct(e-1
TYPE OF JOB/WORK: NEW DD ALT REPAIR OTHER :..1 PhjviC
USE OF BUILDING (cM.2.stfr=�vL�S zd� SPA i
PLUMBING FIXTURES MECHANICAL UNITS [] Electric in-wall heaters(no fee)
Type of Fixture No. of Fixtures Fuel Type Fees Type of Unit No. of Units Fuel Type Fees
Toilet(s) '3 '-' Furnace [E/G/LPG]
Bathroom Sink(s) Heat Pump [E/G/LPG]
Bath Tub(s) o Ductless H.P. [E/G/LPG]
Shower(s) .. " Spot Vent Fan
Water Heater(s) [E/G/L G Propane Tank gal.]
Clothes Washer(s) . [E/o,tL G]-' Gas Outlet(s)
Kitchen Sink(s) \ Heat Stove [E/G/LPG/W]
Dishwasher(s) • Kitchen Exhaust Hood
Hose bib(s) Dryer Vent
Other Solar Panel
Other C Other
Plumbing Subtotal Mechanical Subtotal
Plumbing Base Fee Mechanical Base Fee
Final Inspection Fee Final Inspection 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 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.INACTIVI OF THI ERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
X — 7 lb/'tI3/l_]
_ ignafure Applicant.
X / 144 i� /' 1 wn /Owners Representative/Contractor
Print Name a one)
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
O Building
O Fire Marshal
O Permit Tech (OTC permit only)
\'. a1 '..n- j fwY:'t'1..0 [ „ .. us/corn:n ti ^E'v i 1;. /.