HomeMy WebLinkAboutCOM2018-00035 Deferred Submittal for COM2018-00034 - COM Application - 3/5/2018 MASON COUNTY COMMUNITY SERVICES Permit No. lb •"%�7
PERMIT ASSISTANCE CENTER.
•BUILDING •PLANNING •FIRE MARSHAL
615 W. Alder St- Shelton, WA 98584
www.co.mason.wa.us
Phone Shelton:(360)427-9670 ext. 352• Fax:(360)427-7798 [, 2
Phone Belfair(360)275-4467• Phone Elma:(360)482-5269 G1+ Yl zo I
MAR, 2 1 20 8 PLUMBING & MECHANICAL PERMIT APPLICATION
�p„�iFRATION: CONTRACTOR INFORMATION:
NAME: Les Schwab Tire Centers -WA#409 NAME:Evergreen Refrigeration
MAILING ADDRESS: PO Box 5350 MAILING ADDRESS:727 S Kenyon St.
CITY: Bend STATE: OR 085 CITY:Seattle STATE:WA ZIP:98108
I" PHONE: PHONE:206-763-1744 CELL:
2°d PHONE: EMAIL : alexb@evergreenhvac.com
EMAIL: L&I REG# EVERGRL954R2 EXP. 1 / 6 /20
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number): 12332-50-00036 Zoning: C-3
LEGAL DESCRIPTION(Abbreviated):SAM B. THELER'S HOME & GAR TRS PCL 2 OF BLA#09-46 S 35/88 S 36/104
SITE ADDRESS:23090 NE SR#3 CITY:Belfair, WA 98528
DIRECTIONS TO SITE ADDRESS: Heading north on SR#3 this location is on the east side of the road immediately to
the south of NE Byerly Dr.
TYPE OF JOB:
NEW ADD ALT -+/ REPAIR OTHER USE OF BUILDING
LOCATION OF FIXTURES/UNITS— I ST 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_
l'oilets Type of Unit No.of Units Fees
F3athroom Sink Furnace 1
Bath Tubs Heat Pump
Showers Spot Vent Fan 2
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 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 OFTHIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS
WILL INVALIDATE THE APPLICATION.
X V✓ 3/5/18
Signature of Owner Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
Rev 1/27/2016 1BN