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i CONCRETE MECHANICAL MOBILE HOME
! Footings-Setback date by Ribbons
date by Gas Piping date b
Foundation Walls date by Set Up
date by INSULATION date by
BG/SLAB Insulation Floors Final
date by date by date by
FRAMING Walls FIRE DEPT.
date by date by date by
PLUMBING OTHER
Attic
Groundwork date by
date by WALLBOARD NAILING
D.W.V.
date by date by
Water Line FINAL INSPECTION
date by date by date by
1
L�
PERMIT NO.:
MASON COUNTY
PLUMBING/MECHANICAL PER IT APPLICATION
426 W.Cedar/P.O.Box 186,Shelton,W 98584
Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482 5269 Seattle 206 464-6968
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner .±r)o /Ivn cier-s-on Contractor Name
Mailing Address -?I rV. Mailing Ad �ss
State Zip Code cityJ State , Zip Code
Phoned r} } Other Ph.( Ph. ,Cs �b-` Other Ph.(_�
Lien/Title Holder Contractor # LV iA P NC Iz 10 y„J
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. `1 K- 5 t / / C?UCH Fire District I
Legal Description 1�• Fr s_?
Site Address(Please include street name, stre t number and city)
Di ections to site k c= 4", ., r' � ,. �J �.. ✓ R.�t �,
On L.
Is your property within 200' of the following: Body of Water(Name) Saltwater
Lake River/Creek Pond Wetland Seasonal Rulioff Stream Slopes or
Bluffs
TYPE OF JOB New Add Alt Repair Other Use of Building
Location of Fixtures/Units 1st Floor 2nd Floor Basement Garage Closet
PLUMBING FIXTURES(Show Number of each) MECHAN CAL UNITS F-yel Type: Electric
Type of Fixture No. of Fixtures Fees LPG Natural Gas_ Heatpump
Toilets Type of U it No. of Units Fees
Bath Basins Furnace T— /`
Bath Tubs Heatpum s —� /77
-
Showers Vent Fan
Water Heater Propane fink
Laundry Wsher Gas OUtIE fps
Sinks Wood/Ga 5IPellet Stove
Dishwasher Direct ent?
Other Other
Other Other
Base Fee Base Fee -
TOTAL PLUMBING TOTAL MECHANICAL
A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF FIXTURE/UNIT.
NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHOR$ED 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 ab ve described property and structures for review and
inspection of this project. Acknowledgment of such is by signature below:
OWNER AFFIDAVIT-[certify that I am exempt from the requirements of the CONTRACTOR' AFFIDAVIT-1 certify that I am currently registered as a
Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the si ate 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 regi ilating 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 coinformance therewith. No changes shall be made without
approval. first obtaining aprOval.
�'
X Date X A — Date
FOR OFFICIAL USE BEYOND THIS POINT
Accopted by Date Submittal Amount I ue Receipt No.
. .:::>;;: DER TIti+NTA APPROVE RENIEf3 G4ND[TI4N.4iQRt S:
Building Department
Occ Group Type Constr.
Planning Department
Other
Other
................;:......... «:
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