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N = (D .� -O CL cr n c CD N (D (D o' CD 3 OZ CD Q (D — P :3o lSD SU O CD .+ E in' JAN-26-2011 WED 09 : 48 AM CHEHALIS SHEET METAL FAX No. 3602927456 P- 002 PERMIT N01 jj bUu�/ MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATION 426 W.Cedar- RO.,Box 186, Shelton, WA 98584 Shelton (360)427-$67� Belfalr(360)275-4467■Elma(360)482-5269 n t e we wvvw.Co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner c✓-N ,--4rcr-r Company Name �`�'^ �'°``�' g1 _11 lry\ -ka.i Mailing Addres �40�I 6ri Air o �_10- Mailing Address ° ?--1 '5E: City Sa J", atate Zip Code � City t State SAu 21- Zip Code? Phone 5wi, - Other Ph Phone �' a / („ Other Ph.— Lien/Title Holder -- Contractor Reg. # G 4g'r'2sz",� Exp_y--- E mail address E Mall Address Drivers Lic.# DOB Drivers Lic.# DO>3 SEPTIC INFORMATION - Connect to New Septic — Existing Septic Connect to Sewer System Name of Sewer System -- PARCEL INFORMATION- 12 Digit P cel No o D Fire District Legal Description 2C_ls o ALA ~a`i" 'T� "2-G Site Address(Please Include street name, street number and city) yd-if '4hrca rr� Directions to site eq- Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream—Slopes or Bluffs > 1506 TYPE OF JOB - New Add Alt Repair Other Use of Building Location of Fixtures/Units-1 st 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 Bathroom Sink Furnace Bath Tubs Heatpumps i Showers Spot Vent Fan Water Heater Propane Tank — Clothes Washer Gas Outlets Kithen Sinks Wood/Gas/PelletStove Dishwasher Kitchen Exhaust Hood Hosebibs -- Dryer Vent Other 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 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 worts 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�FCQ �W�ONOFWORK IS BY MEANS OF A PROGRESS INSPECTION. X r. Date: i ` ZCQ'!1 n Fiepreaentative/Contractor (indicate which ona) FOR OFFICIAL USE BEYOND THIS POINT Accepted b Planning Pd Ck#_ Date Bid Pd Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Occ Group e Constr. Planning Department Environmental Health Department FEES Plumbing& Base Fee Site Inspection Mechanical & Base fee UFC Plan Review Fee Wood/Gas/Pellet Stove Fee Other Violation Fee TOTAL FEES co r- CONCRETE Gas Piping MANUFACTURED HOME M C:) li�teror-Date By Footings I Setbacks Pxiopxx-ome By Ribbons C) CD 1)ato By Da te BY C) INSULATION 0') -up fA 0) Found'ation Wall$ G I SLAB INSULATION Set 01 ze By Dale— By Owe By -�Ioors — —-- — FRAMING Da te. By FIRE DEPARTMENT .11—, By 0a te By Walls PLUMBING Date By DECKS L)-A Vault t v BY Groundwork TANKS Date By Oate, BY Date By Attic E)M.V Date By OTHER , Da te By D TypL RYWALL Date BY Water Line Date By Type: Gale By int. Brace Wal I date By e By MECHANICAL apt Fire Seperation FINAL INSPECTION Date By Date RY, Date By ....................... ......... 0 Pass or Request Inspect. 5 Type of Insp. Fall Date Date Done By Comments (D 6 (D :3 a cj� 0 0 5 (D .. ............ O