HomeMy WebLinkAboutBLD2013-00533 Final Heat Pump - BLD Permit / Conditions - 7/11/2013 \ }
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07/00/2013 11: 46 3G04277466 OLYMPIC HEATING PAGE 01i01
FORM MUST BE COMPLETED IN INK
D7��3-,
PLEASE PRESS HARD MASON COUNTY PERMIT NO.
PLUMBING/MECHANICAL PERMIT APPLICATION
426 W.Cedar•P.O. Box 186, Shelton,WA 98584
Shelton (360) 427-967t% Belfair(360) 275-4467• Flma(360) 482-5269
On t e web www.Co.mason.wa.us
APPLICW INFORMATION CONTRACTOR I FORMATION
Owner YIf,\2Pi-( iQjz Company Name
Mailin Address��2 E c)► �in�er.f Ood. Mailing Address -
City state &A- Zip l City 42a+r-�^� Ctate ".)Cr Zip Code
Phone 7Y� -U?16-19/2 Other Ph Phone.�o1-1421n-99us Other Ph.
Lien/Title Holder Contractor Reg.#nk'%CAR � xp.
E mail address E Mail Address OLYM PHCq�(ot�o
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC INFORMATION -Connect to New Septic Existing Septic Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No. Fire District
Legal Description
Site Address (Please include street name, street number and city)
Directions to site
Is property within 200'of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff—Stream—Slopes or Bluffs > 15%
TYPE OF JOB - New Add_Alt._Repair Other Use of Building
Location of Fixtures/Units - 1st Floor, 2nd Floor Basement Garage Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS
Type of Fixture No. of Fixtures Fees Fuel Type:Electric�.. LPGI Natural Gas Heat Pump_
Toilets Type of Unit No. of Units Fees
Bathroom Sink Furnace
Bath Tubs Heatpumps
Showers Spot Vent Fan
Water Heater Propane Tank
Clothes Washer Gas Outlets
Kithen Sinks Wood/Gas/Pellet Stove
,Dishwasher Kitchen Exhaust Hood
Hosebibs Dryer Vent
Other Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
CMMER/BUILDER Acknowledges submission of inaocurate information may result in a stop work order or permit revocation.Admowledgement of
such is by signature below.I declare that 1 am the owner,owners legal representative,or the contractor.I further declare that I am entftled to receive this
permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary parties.If permission is
required from any easement holder or any other party in interest regarding this application or the work proposed in the application,I halve obtained
permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represems that the infomration
provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection.
PRO F F ONTIN N QF WORK IS BY MEANS OF A PROGRESS INSPECTION.
X 4 45--� Date: 1 -3 -Z.O I -'tl
Owner/Owners Rapreser."u/Contractor (Indicate which one)
FOR OFFICIAL USE BEYONDTHIS POINT
Accepted by: Planning Pd Ck# Date Bid Pd Receipt No.
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Occ Group-Type Constr...�.�.
Planning Department
Environmental Health Department
FEES
Plumbing & Base Fee I Site Ins action
mechanical &Base fee 1UFC Plan Review Fee
Wood/Gas/Pellet Stove Fee Other
Violation Fee TOTAL FEES