HomeMy WebLinkAboutBLD2000-00316 SFR - BLD Application - 3/21/2000 4PR M/I�r
MASON COUNTY
PLUMBING/MECHANICAL PERMIT APPLICATION
426 W.Cedar/P.O.Box 186,Shelton,WA 98584
Shelton(360)427-9670 Belfair(360)275-4467 Elma(360)482-5269 Seattle(206)464-6968
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner . '" AJ ; k� i Contractor Name A .1yi
Mailing Address, .5" '7- Mailing Address
City_ , V'r.ZA'At wAState W) Zip Code Sk city State Zip Code
Phone( 0 ) 11;6-11//Wther Ph.( Ph.(__ Other Ph.0
Lien/Title Holder— 4A- A4 E Contractor Reg. #
Address Expiration
[SEPTIC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of
SEP
TIC
System
PARCEL INFORMATION-12 digit Tax Parcel No. yO_ Fire District
Legal Description
Site Address(Please include street name, street number and city)
Directions to site y A) Tri 7' T,x
Oagl', .1jer &VA T i`�__02&4 44 tA S:A 4) Al
Is your property within 200' of the following: Body of Water (Name) _k L, Saltwater
Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or
Bluffs
[ P OF JOB New Add—Alt Repair_Other Use of Building TYPE
of Fixtures/Units 1st Floor 2nd Floor Basement Garage_ Closet
PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Fuel Type: Electric
Type of Fixture No. of Fixtures Fees LPG Natural Gas_Heatpump
Toilets Type of Unit No. of Units Fees
Bath Basins Furnace
Bath Tubs Heatpumps
Showers Vent Fans
Water Heater Propane Tank
Laundry Wsher Gas Outlets
Sinks Wood/Gas/Pellet Stove
Dishwasher -birect Vent?
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 AUTHORIZED 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 above described property and structures for review and
inspection of this project. Acknowledgment of such is by signature below:
OWNER AFFIDAVIT-1 certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a
Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State 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 regulating 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 conformance therewith. No changes shall be made without
approval. first obtaining approval.
LM6_e� Date X _T, -4 j Date.
FOR OFFICIAL USE BEYOND THIS POINT
z)
Accepted b —Date Submittal Amount Due Receipt No.
DEPARTMENTAL RMEW AVPROVED DENIED:1 CONOTTION CODES::
...........
Building Department
Occ Group Type Constr. 3&11 C)o
Planning Department
Other
Other
PEEg
Permit Fee Site Inspection
Plan Review Fee LIFC Plan Review Fee
Plumbing&Base Fee Other
Mechanical&Base Fee Other
Wood/Gas/Pellet Stove FeeSubmittal
Violation Fee TOTAL FEES