HomeMy WebLinkAboutBLD2024-01122 Mechanical - BLD Application - 9/17/2024 MASON COUNTY COMMUNITY SERVICES Permit No: S�2k--n7 02. - pli 2 2
PERMIT ASSISTANCE CENTER:
BUILDING •PLANNING -FIRE MARSHAL RECEIVED
615 W.Alder St-Shelton,WA 98584
www.co.mason.wa.us
Phone Shelton:(360)427-9670 ext.352• Fax:(360)427-7798 SEP 1 7 2024
Phone Belfair. (360)275-4467- Phone Elma:(360)482-5269
PLUMBING & MECHANICAL PERMIT APPLICAT10TS15 W.Akfer Street
OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: GLte-cy 1 En 'cld + NAME: 1^/e-
MAILING ADDRESS: (ooZ C�JS tgi194 MAILING ADDRESS: o +D?c Zco
CITY: STATE:_/,f)14 ZIP: JBr�S CITY:S.,e-llv�- STATE: w A ZIP: -IRs--Sy
15'PHONE: PHONE: CELL: Lz�&p &88 - O&7
2nd PHONE: EMAIL: c,/ R kw• cop-
EMAIL: L&I REG# txp.
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number): �J J-L I - 9 3 q O 2-1 O Zoning. (LR r5
LEGAL DESCRIPTION(Abbreviated): 21 pV SDI SE T R 0�--7 Sp 11 S I W
SITE ADDRESS: bog tom. i RviE CITY: t-t000sPorzlr
DIRECTIONS TO SITE ADDRESS:
TYPE OF JOB:
NEW ADD ALT REPAIR OTHER USE OF BUILDING
LOCATION OF FIXTURES/UNTTS—1sT FLOOR 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 Ductless_
Toilets Type of Unit No.of Units Fees
Bathroom Sink Furnace
Bath Tubs Heat Pump
Showers Spot Vent Fan
Water Heater Propane Tank
Clothes Washer Gas Outlets
Kitchen Sinks Wood/Gas/Pellet Stove
Dishwasher Kitchen Exhaust Hood
Hose bibs Dryer Vent
Other Solar Panel
Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
OWNER acknowledge 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 OFTHIS PERMIT IS BY MEANS OF INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS
WILL INVALIDATE THE APPLICATION.
X
Signature of Owner Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
Rev 1/27/2016 JBN