HomeMy WebLinkAboutBLD2017-00138 Plumbing - BLD Application - 2/23/2017 MASON COUNTY PERMIT NO. idZO1 13
y DEPARTMENT OF COMMUNITY DEVELOPMENT Q�3( _�/�
BUILDING.PLANNING• FIRE MARSHAL DD 3� I
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
J&V PO Box 279, Shelton,WA 98584 (360)482-5269 Elma ext. 352
PLUMBING & MECHANICAL PERMIT APPLICATION
OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: C1o(L NAME: j,J T Ef}TFt2
MAILINQ ADDRESS: ( ( { MAILING ADDRESS: (�� 15 N G12eEK P u,�/S (_1 ca
CITY: STATE: ZIP: CITY: gtrl �'1 (;I I STATE:1.A/ _ZIP: I
PHONE: 31 p 13, ELL: PHONE:`-f a � CELL: —
EMAIL: EMAIL : S &4-e,, o-fl c-
L&I REG#_fAST�`'�I-t`�yS�RC F-xP. I / /
PARCEL INFORMATION:
PARCEL NUMBER(12 DIGIT NUMBER): l
LEGAL DESCRIPTION(ABBREVIATED):
SITE ADDRESS: CITY: 1�
DIRECTIONS TO SITE ADDRESS: S N _Sr S
TYPE OF JOB
NEW ADD ALT PAIR RX OTHER USE OF BUILDING
LOCATION OF FIXTURES/UNITS— 1 sr FL O 2ND FLOOR BASEMENT GARAGE OTHER
PLUMBING FIXTURES(SHOW NUMBER OF EACH) MECHANICAL UNITS
Type of Fixture No. of Fixtures Fees Fuel Type:Electric LPG Natural Gas Heat mp_
Toilets Tvne of No. of Units Fe s
Bathroom Sink Fu ce
Bath Tubs H atpump —
Showers pot Vent Fan
Water Heater Propane Tank
Clothes Washer Gas Outlets
Kitchen Sinks Wood/Gas/Pellet Stove
Dishwasher Kitchen Exhaust Hood
Hosebibs Dryer Vent
Other ther
Base Fee Base Fee —
TOTAL PLUMBING (�la.t-I TOTAL MECHANICAL
OWNER I 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 of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OF INSPECTION.INACTIVITY OF THIS
PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. a
X I i aA, rh
Signature of App ant Date
�Y � L M
x
Owner/Owners Representative/Contra&r w
Print Name (indicate which one) "'` c
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL