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MASON COUNTY PERMIT NO. ,`G� �
DEPARTMENT OF COMMUNITY DEVELOPMENT E
BfW NG*PI WNING-FIRE MAR5WA _
Nt on GostrriY Bldg_fit,d/26 Vilest Cedar�Stnaet (360)275�15o Bet!✓air axt.352 O 2
PO Box 279,S#halton,WA 98684 (360)482-5269 Eimer exL 352
PLUMBING & MECHANICAL PERMIT APPLICATION
OWNER A
igQW994CTORM RMATIO
NAME NAME: c1
MATLJN ADDRESS: bMAILII�C SS:
CITY STATE: LTN C= STATE: W A- _._.
kII013B:300 42�Ca 9Z$� CELL: PHONES 0 q CELL:
EMAIL: -- EMAIL : n G t'Y1S!1 •(�l�'1
Lw
PARCEL NUMBER(12 DIGIT NUNS 1 Z L] O 1
LEGAL DES Q�t( �'D}:
SM ADDRESS: �{{ C'T CITY: EL"inn
DMF�ONS TO SffE ADDRESS:
TYPE OF 3019
NEW ADD ALT REPAIR OTHIK USE OF BUILDING
LOCATION OF FIX -1'r FLOOR 2W FLOOR BASEMENT�GARAGE OTHER
PLUMBING FJ7i.Ti JRES(9KOW NUMBER OF EACH) 1V�Ei'BANICAL
ape of•Fix�ae NO.o£� � Fuel TypeElet Nalvral Gas.__HeatTt=p
Toilets BW aeUh3it
Batlttnom Sink Fturrarti
Bath Tabs aemninip — --
Showcrs __ _ Spot Sleet Fhm
Watcr Heamr Propane Tank
Clothes Washer Gas Outlets
Kiteb n Sinks SJVood/t^rds/Pellot Stove
Dish'washcr Kitchen Exhaust Hood
Hosebnbs _ Dryer Vent
Other Other
od
Base Fee Base Fee
TOTAL PLLTU BING TOTAL MECHANICAL
OWNER/BUILDER acJQhamedges submission of lna=nate infotmation may result in a stop work order or permit revocation.
Acknow%dgernerst of such is t y signature below.l dedam that I am the owner,owners legal representative,or contractor.I further decWe
that I am entitled to r%eive this PM t and to do the work as proposed,i have obtained permission from all ft necessary Parties,including
any easement!wiles or parties of tttt%VSt regarding this project The omier or attihortzed agent represents trial the informaton provided is
accurate and grants emp"Oes of Mason County a to ft above deaeribed property and structure(t)for review arhd inspection.This
Perr &void If work or authored t�rhsttuctFon is not commenced within SO days or if corvction wont is
s eR7 of E ys.PROOF OF CONTINUATION OF WORK tS BY IiI1=AAtS OF INSPECTION.INAGTMTY OF THIS
t tCA OF DAYS INVALIDATE THE APP1(CATION.
�4Zat
Sa nature Ck AppIrcant Date
x Owner/Owners Contractor
print a (indicate whkh o
BUIL➢ING DEPART NEI NT
P'LANNTNG DEPAR'I',iviENT
FIRE MARSHAL.
90I50 39vd 9NIlv3H OIdNA-10 99bLLZb09 L0 :bT LT0Z10ZIb0