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WALLBOARD NAILING date by date by Water Line FINAL INSPECTION date by date by C�4 date by h PG i-A,t 1, i FA, Q CA DW PC F3 Zg o z- F'W A I- A,s I I � PERMIT NO.: MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,W 98584 Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 4 2-5269 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner Contractor'Name Mailing Address Mailing Address City State Zip Code City State Zip Code Phone(__) Other Ph.(---) Ph. Other Ph.( Lien/Title Holder Contractor,Reg. # Address Expiration SEPTIC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION- 12 digit Tax Parcel No. / / l p U /U Fire District Legal Description I Site Address(Please include street name,street number and city) i / a 1 Directions to site ago Is your property within 200'of the following: Cody of Water(Name) _ tr? Saltwater Lake River/Creek Pond Wetland easonal Runoff Stream Slopes or Bluffs 9 TYPE OF JOB New Add Alt Repair Other Us of Building Location of Fixtures/Units 1st Floor 2nd Floor B-asement Garage Closet PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS Fuel Type: Electric Type of Fixture No.of Fixtures Fees LPG Natural Gas Heatpump Toilets Type of t No.of Units Fees Bathroom Sink Furnace Bath Tubs Heatpum 's Showers Spot Vent i Fan Water Heater Propane ank Clothes Washer Gas Outl s Kitchen Sinks Wood/Ga /Pellet Stove Dishwasher Kitchen Exhaust Hood Hosebibs Dryer Ven Other Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPEN 'ING ON THE TYPE OF FIXTURE/UNIT. NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structures for review and inspection of this project. Acknowledgment of such is by signature below: OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTORS AFFIDAVIT-I certify that I am currently registered as a Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the'!State of Washington and that I am aware of the ordinance requirements for which this permit is issued and that all work will be done in requirements regulating the work for which this permit is issued and all work conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval. first obtaining apt oiroval. X Date X Date FOR OFFICIAL USE BEYOND T1111IS POINT Accepted by Date Submittal Amount Due Receipt No. AkFAf4TAfEENTAIT:Ft1^4liEW' R}?f"Rt]VW :.<RENIE#} :.. G0fRiTl43hi CORES Building Department , Occ Group Type Constr. Planning Department Other Other ................................................................................................................................. wxs Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee'. Plumbing&Base Fee Other Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal Violation Fee TOTAL FEES I