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CD Type of Insp. Fall Date Date Done By Comments C) CD 40 81 57 2 (0 0) CD 0 0 :3 CL 0 =3 . ................................. CA 0 Cn -0 CD CD 0 MASON COUNTY COMMUNITY SERVICES Building.Planning,Environmental Health,Community Health Physical and Mailing Address: 615 W Alder St.,Bldg 8, Shelton, WA 98584 Shelton Phone: (360)427-9670 ext 352 ❖ Fax (360)427-7798 PLUMBING & MECHANICAL PERMIT APPLICATION Permit#: OWNER INFOR TION: J CONTRACTOR INFORMATION: NAME: I e_ NAME: MAILING DDRESS: lye & �. MAILING 1�DR SS: �'( a r CITY: e �, STATE: ZI . V CITY: �S t STATES a ZI 1st PHONE: �6C) L1V-&o?S2 PHONE: CELL:3W' x)--S973 2nd PHONE: y EMAIL : ' c c d4om EMAIL: L&I REG#_ EG— EXP.S / 19 PARCEL INFORMATION: PARCEL NUMBER (12 Digit Number): JQ 2-7" 63-- 0011 Zoning: LEGAL DESCRIPTION (Abbreviated: SITE ADDRESS: ((© e z CITY: s.,f wit DIRECTIONS TO SITE ADDRESS: TYPE OF JOB/WORK: NEW �.J ADD ALT REPAIR OTHER USE OF BUILDING PLUMBING FIXTURES MECHANICAL UNITS [] Electric in-wall heaters(no fee) Type of Fixture No. of Fixtures Fuel Type Fees Tvpe of Unit No. of Units Fuel Type Fees Toilet(s) Furnace [E/G/LPG] Bathroom Sink(s) Heat Pump [E/G/LPG] Bath Tub(s) o Ductless H.P. � [E/G/LPG] Shower(s) Spot Vent Fan Water Heater(s) [E/G/LPG] Propane Tank L gal.] Clothes Washer(s) [E/G/LPG] Gas Outlet(s) Kitchen Sink(s) Heat Stove [El G/LPG/W] Dishwasher(s) Kitchen Exhaust Hood Hose bib(s) Dryer Vent Other Solar Panel Other Other Plumbing Subtotal Mechanical Subtotal Plumbing Base Fee Mechanical Base Fee Final Inspection Fee Final Inspection Fee TOTAL PLUMBING TOTAL MECHANICAL 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 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 OF WORK IS BY MEANS OF INSPECTION.INACTIVITY OF THIS PERMIT APPLICATI DAYS WILL INVALIDATE THE APPLICATION. x Fature o I W> pt Date x U fit c. c �s c'�-- _ , Owner/Owners Representative/Contractor Print Name (Circle one) DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS O Building O Fire Marshal O Permit Tech (OTC permit only) Rev':i(t)8t:Z4.7..�