HomeMy WebLinkAboutBLD2013-00250 Cancelled Mechanical - BLD Application - 3/11/2015 04/10/2013 06: 30 3604277466 0L',1P9PIC HEATING PAGE 01/01
FORM MUST BE COMPLETED IN INK 1J PERMIT N0. L,
PLEASE PRESS HARD MASON COUNTY
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
APPLIC/ VT INFORMATION CONTRACTOR INFORMATION
Owner 1 SZ.��2�� �')(»r inL�rv� Company N e
Mailing Addres l Mailing Addr S.
Cit_ i C Cl.- d State _Zip Code ity State Zip Code
Phone "' >4E1`C-;I SL Other Ph I one Other Ph,
Lien/Title Holder C nt or g. Exp.
E mail address E I dd s
Drivers Lie.# DOB ri DOB
SEPTIC INFORMATION - Connect to New Septi i ting Septi Connect to Sewer System
Name of Sewer System
PARCEL INFORM A O 12 Digit Parce No. Fire_District
Legal Description
Site Address (Please clude str t na e, s et nu Aber and city)
Directions to site— ti
Is property within 200' Saltwate Lake River/ Pond
Wetland—Seas Stream Slo es or DUNS 15
TYPE OF JOB - New Add Alt,__Repair 0rher 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
Batb.room Sink Furnace
Bath Tubs Heatpumps
Showers Spot Vent i=an
Water Heater Propane Tank
Clothes Washer Gas Outlets
Kithen Sinks Wood/Gas/PeiletStove
Dishwasher Kitchen Exhaust Hood
Hosebibs Dryer Vent
Other Other
Base Fee Base Fee
TOTAL P UMBING TOTAL MECHANICAL
0VVNER/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 parry In Interest regarding this application or the work proposed in the application,I have obtained
permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information
provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection.
PROOF PF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION.
X Date: 4-IO--Z0 t2�
Own r/Owners Reprosen tive!Contractor (In cate which one)
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by: Planning Pd Ck# Date Bid Pd Receipt No.
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Occ Group-Tyne Constr.- _
PlanninQ Department
Environmental Health Department
FEES
Plumbinq & Base Fee Site Inspection
Mechanical & Base fee UFC Plan Review Fee
Wood/Gas/Pellet Stove Fee Other
Violation Fee TOTAL FEES