HomeMy WebLinkAboutBLD2014-00949 - BLD Application - 9/22/2014 Oct 16 2014 01:49PM HP Fax page 2
MASON COON', PERMIT NO. d-coq4q
DEPARTMENT OF COMMUNITY-DEVELOPMENT
BUILDING-PLANNING•FIRE MARSHAL
WWW.CO.MASON.WA.US (360)427-9670 Shelton ext.352
Mason County Bldg. III, 426 West Cedar Street (360)275-4467 Belfair ext. 352
PO Box 279,Shelton, WA 98584 (360)482-5269 Elma ext.352
PLUMBING & MECHANICAL PERMIT APPLICATION
OWNER INFORMATION: TRACTOR INFORMATION: ,
NAME: NAME..:�,�'�-f� �r s�i,.: '61"
MAILING ADDRESS: r/,/R / GU /�on MAILING ADDRESS: -Awa' S. %dr'' ee,14.4- ica� 4- /fir
CITY: SA lf G,,�- STATE:W,,.� ZIP:Q �>; ! CITY: STATE:C.,L " ZIP: 'rd•s i •�
PHONE: I<go �iJ� YQ� CELL: PHONE: C;�6u�/,4i� .fdi�/ CELL:
EMAIL: EMAIL ._em/e
L&I REG G
PARCEL INFORMATION:
PARCEL NUMBER (12 DIGIT NUMBER):
LEGAL DESCRIPTION(AHBREi11.ITED):
SITE:ADDRESS: YYY/ I-J. J r,•- 4t f 0gorlr CITY:
DIRECTIONS TO SITE ADDRESS: - ?S ��r �'oc�J - ✓;. .,hr v.,rY
i�o6t - ��4 3/ '�Cec,ct 1C�U � �)s•t fie. ft"�E i��}/ac1� •t'e� Cara /t•�R"t Ot. r�/iUz=u.•�...
TYPE OF JOB
NEW ADD ALT REPAIR OTHER USE OF BUILDING
LOCATION OF FIXTURES/UNITS— I ST FLOOR 2N"FLOOR BASEMENT GARAGE OTHER
�f:UMBING FIXTURES(SHOW NUMBER OF EACH) MECHANICAL UNITS
Type of Fixture No. of Fixtures Fees Fuel Typc:Electric LPG Natural Gas Heat Pump_
1 Toilets Type of Unit No. of Units Fees
I Hathroorn Sink Furnace
,
Bath'tubs Heatpwnp /
1 Sliew-ers Spot Vent Fan
Water Heater Propane Tank
Clothes Washer Gas Outlets
j Kitch n Sinks Wood/Gas/Pellet Stove
f Pisliw•asher Kitchen Exhaust Hood
Hosebibs Dryer Vent
Other Other '
/51,d o 4";r r1c
Base Fee e d c� f 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
permitlapplication becomes null&void if work or authorized construction is not commenced within 180 days or if construction work is
suspended for a period of 180 days.PROOF OF CONTINUATION OF WORK IS BY MEANS OF INSPECTION.INACTIVITY OF THIS
PERMIT PPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
Signs ure 6f Applicant V Date
X 1-)4 — — Owner/OwneM g!=- ula��ct®or
Print Name (indicate which one)
O- E:PARTMENTALREVIEW APPROVED llATE DENIED DATE TAGS/NOTES/CONDITIONS
(BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
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