HomeMy WebLinkAboutBLD2016-01026 Heat Pump - BLD Permit / Conditions - 10/12/2016 co
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MASON CovNTy PERMIT NO. �� db)b 2(�
DEPARTMENT OF CO!{r�lk UNITY DEVELOPMENT
BUILDING•PLANNING.FZRE AMRSHAl-
W.CO.IVIASON WA U5 (360)427-9670 Shelton ext.352
_. Mason County Bldg. 111,42e West Cedar Street
PO Box 279,Shelton,WA 98584 (360)275-�07 Beiiair ext 352
"= (360)482-5269 Elma ext 352
PLUMBING & MECHANICAL PERMIT APPLICATION
Ow?\iER INFORMATION: CONTRACTOR IN-FoILR'SATION:
T 1 f
MAILIN ADDRESS: G�c NAME: �hCkA 1� ec A t cc ti C
3 E vJ Oro MAKING ADDRESS: P,C. �5a�c
CITE': �v q STATE:_
-- — IP: 2 CITY: �� � STATE- "IV
ZIP: at e
EMAIL - ELL: PHONE
EMAIL: (&-)-�� -Q�'JCELL:3 Q,01-1li�=�i 3
EMAII, 5 - r Ak e dta-11
Cc f. CG ri
-2
� L&I REG-„i :�. ..jCS ESP.
P
ARCELNFORMATION:UMBER(I2 DIGIT Nlj-_MSER):SCRIPTION{4BBREY ,7D):RESS: � CTIY:U.n I �1✓1
NS TO SITE ADDRESS.
TYPE OF JOB
'�E ADD ALT REPAIR OTHER USE OFBL-MDR�G LOCATION OF FIXtU-R--�TS—Isr FLOOR 2:zDFLOOR BASENILNrT GARAGE OTHER
PLL:VIBL G FLXTURES(SHOW N`TTJ-LASER OF EA
TuneT�e of Fixture No.ofFixtwes �, MECHA-NIC-�L U-NM
Toilets Fees Fuel Type:Eiectric LPG Natural Gas Heat Pump_
Bathroom Sink Tvx ofUrut No.oflinits Fees
Bath Tabs Furnace
Showers HeatpijmP
Water Heater Spot'Vent Fan
Clothes usher Propane Tank-
Kitchen Sinks Gas Outlets --�
Dishwasher \rood/Gas/Peiiet Stove
Hosebibs Kitchen Exhaust Hood
Other Dryer Vent
Other
Base Fee
TOTAL PLi�?�.�BLvG Base Fee
TOTAL-3vIECHA'L\jCAL OWNER/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 infom;a6on 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 NTINUATION OF WORK IS BY MEANS OF INSPECTION.INACTIv1 i Y OF THIS
PERMIT APPLICATION OF t8d DAYS WILL INY�DATE THE APPLICATION.
Signature of Applicant Date
X_
Owner/Owners Reoresentative/Contractor
Print Name (indite which one)
:DEPARTz ?�TAL.REPV4fFPIIrJTi3 - DNIID 3331 TGSfi1i(?£ .5£8 ? t3NS
BUILDING DEPARTN EINT i
PLANNING DEPARTMENT � f
FIRE MARSHAL �