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III,426 West Cedar Street (360)275-4467 Belfair ext.352 :g PO Box 279,Shelton,WA 98584 (360)482-5269 Elma ext.352 PLUMBING & MECHANICAL PERMIT APPLICATION OWNER INFORNIATION: CONTRACTOR INFORNLATION: NAME:GREG AND WENDY VANDEL NAME: C.S.M. MAILING ADDRESS:91 w PINE AcREs wAY MAILLN;G ADDRESS: 350 SW RIVERSIDE DR CITY: SHELTON STATE:wA ZIP:96584 CITY:CHEHALIS S), ATE-'WA ZIP: 98532 PHON`E:253.632.9167 CELL: PHONE:3rc742 9221 CELL: fi EMAIL: .ENTAIL: CHEHALISSHEETMETALOLYd(-C)MCAST NET L&I REG#. GH EHASM262V EXP. 09 !1 24 / 16 f PARCEL IPTFORNIATION: I PARCEL NUMBER(12 DIGIT NUMBER): +Arng lei_ �j�(Q 3 F LEGAL DESCRIPTION(ABBREYL4TED): SITE ADDRESS: 91 W PINEACRES WAY CITY: SHELTON I DIRECTIONS TO SITE ADDRESS:Head east on WA-102 E toward W Pine Acres Way 3. T 1 fr f 1N PjnP AI'CP-Sw2jl --- 3 i TYPE OF JOB ne Acres way NEW ADD ALT REPAIR OTHER USE OF BUILDIING LOCATION OF FLY.TURES/UNITS—IST FLOOR 2"D FLOOR BASEMENT GARAGE OTHER PLLJMBING FLX-TLRES(SHOW NUMBER OF EACH) MECHANICAL UNITS Type of Fixture No.Of Fixtures Fees Fuel Type:Eieetric LPG Natural Gas Ductless ' Toilets Type of Unit No.of Units Fees Bathroom Sink Furnace l Bath Tubs Heat Pump Showers Spot Vent Fan GL'ater Heater Propane Tank Clothes Washer Gas Outlets Kitchen.Sinks Wood/GasiPellet Stove Dishwasher Kitchen Exhaust Hood ' Hose bibs Dryer Vent Other Solar Panel Other Base Fee Base Fee TOTAL PLUMBING TOTAL VIECILANIC.AI. OWNER I 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 g any easement holder or parties of interest regarding this project The owner or authorized agent represents that the information provided is l 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 PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. X PATTY MATH USZ 201 6 `r21tl;*'7:09 -07'00 Date ` X P. MATHUSZ Owner/Owners Representative(Contractor> Print Name (indicate which one DEPARTMENTAL REVIEW APPROVED BATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT FIRE NLARSHAL K l