HomeMy WebLinkAboutBLD2003-01513 plumbing - BLD Application - 2/17/2016 .SON coa MASON COUNTY COMMUNITY SERVICES permit No -lGi 2003 6!S 1.3
PERMITASSISTANCE CENTER:
` .BUILDING•PLANNING•FIRE MARSHAL
615 W. Alder St-Shelton, WA 98584
Phone Shelton:(360)427-9670 ext. 352 Fax:(360)427-7798
— Phone Belfair. (360)275-4467 Phone Elma:(360)482-5269
1854
PLUMBING & MECHANICAL PERMIT APPLICATION
OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: L e46CJ4 A e" 0 N NAME:
MAILING ADDRESS—530 g• MAILING ADDRESS:
CITY: a� �rf' STA E: G1,4, ZIP: R 2 g CITY: STATE: ZIP:
1n PHONE: ?, �0 16—0$ PHONE: CELL:
2°a PHONES EMAIL :
EMAIL: L&I REG# EXP.
PARCEL INFORMATION: q 1
PARCEL NUMBER(12 Digit Number): ` �.Z d ) — Z 00 OD Zoning-
LEGAL DESCRIPTION(Abbreviated): It TLIM U V), 6 1
SITE ADDRESS: El 590 ITY:
DIRECTIONS O SITE ADDRESS: hl v Z (.l�F eN Ulm C
ro r
TYPE OF JOB
NEW ADD ALT�_REPAIR OTHER USE OF BUILDING
LOCATION OF FIXTURES/UNITS— 1sT FLOOR 2ND FLOOR BASEMENT GARA OTHER
PLUMBING FIXTURES(SHOW NUMBER OF EACH) MECHANICAL UNITS
Type of Fixture No. of Fixtures Fees Fuel Type:Electric LPG Natural Gas Ductless_
Toilets Type of Unit No.of Units Fees
Bathroom Sink Furnace
Bath Tubs Heat Pump
Showers I-sd. Spot Vent Fan
Water Heater Propane Tank
Clothes Washer Gas Outlets
Kitchen Sinks Wood/Gas/Pellet Stove
Dishwasher Kitchen Exhaust Hood
Hose bibs Dryer Vent
Other Solar Panel
Other
Base Fee Base 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 pf 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OF INSPECTION.INACTIVITY OF THIS
PERMIT APPLICA N OF 180 DAYS WILL INVALIDATE THE APPLICATION.
x t 2- /-7— /fP
nature of Applicant Date
x �l11�Q.t CCot���— Owner Owners Representative/Contractor
Print Name ircle one)
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
Visit us on-line: http://www.co.mason.wa.us/community_dev/ Rev:''/27!2J_6 JBN