HomeMy WebLinkAboutBLD N/A Plumbing - BLD Application - 11/25/2008 NOV-25-2008 TUE 03:48 Phi FAX NO. P. 01
11/25/2008 10:24 FAX 300 427 7798 MASON CO PERMIT CTR Q 001
i
PERMIT NO.
MASON COUNTY
PILUIMBIWGJMECHAPICAL PERM APPLICATION
426 W.Caayar e . .Bex 166,Shelton, A B8684
Sheltonl1(360)427-�67 a Be aIr(360)275-4467-Elms.(360) 482.5269
n ew w. cp. gson.wa.us
APPLI,C,,ANT INKIRMATION CONTRACTOR I O NATION
Owner r'e „��'�11jQ1Ya Company Name
Mailing Address LI�► Malling Address
City State Zlp! ode City etate Zip Code
Phase c- � — or Ph L4Wn Phone Other Ph.
Lien/Title Holder . VAJA Contractor Reg. a Exp.
E mail address,_.i— W` 1: E Mail Address
privers Llc,a +_ Doh Drivers Llc,# DOB
SEPTIC INFOR114ATIION - Conrtaect to New Septic Existing Septic Connect to Sewer System
Name of Sewer S 'etom
PARCEL INFORMA'ION-12 Digit Parcel No. Fire District 5
Legal Description,LcJrze L( 14-'ri3.C± 15 —She Address(Ple�ise Include stra4 n me:street number and clt
Dir ctions to site �'r �� X L., a-.,,i�
_K Tkvx
2
Is property within,�_00 a>f 5altwate Lake 'Jar/Creek Pond
Wetland .-Seesonal Run6ff_Strs&m_______8loP4 or Bluffs > 15 _ - -
TYPE OF JOB - Nem, Add Alt_Repair Other Use of 6 ding
Location of Flxturva/UrElts-1 st Ft o 2nd Floar Base rnant Gera a Cl oset—
PLUMBING FilCl LES ow um sac M AL UNITS
jyoe of fixture _ , of Fixture $ uel Type:F_reWc__ LPa_ Natural Gab- - Fleet Pump_,..,
Toilets Tvi)e of Unit Fam
Bathroom Sink Fu
Both Tubs _ HAAtpumps
Showers Spot Vert Fan
Water He r _ Propane Tank
Clothes W _ Gas Outlets
Klthen Sinks Wood/Gasa'Pellet s.eL'lC�c�
Dishwasher Ktchen E% cod
Hoseblbs _ Dryer Ve
Other — Othe
Base Fee a Fee
TOTAL.PLU BING OTAL
CANNER/ ,AoJoxwIedgoe submTixaion of inaeeurato Into th"mmobMinod
y mault In stop order or perm rewoatlon.AekrimMedgement of
audt is by signature aelOW!daadilre that am fie owner,corn ntatiw,or lna tractor.I further declare that i em entitled to rewlw this
psrmk and to do the work as¢Arcaosed In application_I that nrission from all the nocamary parties.If psrttdssion A
required from any saaament folder or atrn lo; pi ty regarding this a pi or the work proposed In Me appllwatlon.I haws obtained
perynimlon from them to aplxY torthkt perk rtlt end the work proposed. r or agent on owners behall,represents that the Inl0frnallon
provided E arr mte sand nrnts f��e�yy of W="to the d"Wbed property and struotum for review and inspection.
P (✓OF i�N1>rl1WORIty16 RY OF A PRQGR 6PECTIQN.
Date:
Owner/0mie-re F,opreaseratativs/contactor (andinatP one)
FOR OFF AL USE BEYOND THIS POINT
Accepted by-,_—Planning P CbN Date Bid Pd Reeelpt No.
DEPARTMENTAL FIEVIEW APPROVED DENIED NOTES
Suildinp Department
Occ Croup.7ypa�`
Plamminq Department
Environmental Health Department]
FEES
Plumhlrlo &Basio 1=66 Site Inspection
MechanIcal&Bae1.121 w Fee
Wood/Gas/Pellet Stove Fee Ot er
Violatjon Fee TOTAL FEES
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