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12/17/2018 13: 00 360427746E OLYMPIC HEATING PAGE 01/01
MASON COUNTY
COMMUNITY SERVICES,,
Building,Planning.Environmental Xealti%Cpmmmtty Htat{h"
Physical and Mailing Address: 615 WAlder St,Bldg 8,Shelton, WA 98684
Shelton Phone: (360)427--9676 Bx1352 P Fax (360)427-7798
PLUMBING & MECHANICAL PERMIT APPLICATION Powmit#: Id a19) ' 0 tM I
OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: Yt Y NAME: Ok c.-
MAILING ADDRESS: V0 1 O MAILING ADDRES:J 1—se; o`nejxv
CITY:L �. n STATE: W ZIP: y CITY: She.my-1 STATE: 1A S A_ZIP: Gt�
1st PHONE: ' 3t07;9o_SI'1 Lr PHONE:��,c��t?�9�f45 CELL:
2nd PHONE: -- - EMAIL: o h t��'�S�Lm5 r�.Ca++'►
EMAIL: L&I REG# O L-Y MP 4�R S to E -EXP. I I. _
PARCEL INFORMATION:
PARCEL NUMBER (12 Digit Number: 3 Z2'� tQ`151-ocb 3 Z Zoning:
LE GAL.DESCRIPTION (Abbreviated): Pe_ F �Pa_e�_- VIFN O: - L-ot- iz T�� L• 3
SITE ADDRESS.T3 6 6 F Sfe,- e- D CITY:
DIRECTIONS TO SITE ADDRESS:
TYP) CQ€.J4E!WQRK NEW ADD ALT REPAIR OTHER
-USE OF BUILDING
:PLUMBING FIXTURES M1EC! ANjCAL. UNITS []Electric in-wall heaters inofoe)
yoe of Fixture ' No.of Fixtures A ml Tyne Fees Type of Unit No.of Units Fu 1 Tme Fees
Toilet(s) .
Fumace PG/LPG] .
Bathroom Sink(s) Heat Pump PG/LPGI
,Bath Tub(s)' o Ductless W.P. g,IJ:G/LPG,
5h'ower(s) Spot Vent.Fan
Water Heater(s) [E/G/LPGI Propane Tank
Clothes.Washer(s) iE/G/LPGj Gas Outlet(s)
ritchen Sink(s) Heat Steve .Oishwasher(s) Kitchen E haust Wood
Hose bibs) Dryer VentOther Solar Pattie)
Other Other
Plumbing Subtotal Mechanical Subt tat
Plumbing Base Fee M®chaMcal Base
fAUM 1nl`=s2o.Fee _ ,�naLLrltsr�ectian Fee la'iq®11�
TOTAL PLUMBING TOTAL MECHANICAL
OWNER f BUILDER acknowledges submission of inaccurate information may result in a stop wt*k order or permit revocation.Acknowledgement of such is
' y°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 grant&employees of Mason County access to the above '
described property and structure(s)for review and inspection.This permltlappiication bammes 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
1NSF' CTION.INACTIVITY OF THIS PERMIT APPLICATION OF 480 DAYS WILL.INVALIDATE THE APPLLCA-I6N.
x ` 211-7 (157
Si§natA of Ap "cat
x U _Owner/Owners Representative/Coritractor
Print Name (Circle one)
DEPARTMENTAL RIr1/i1:.W APPROVED DATE DENIED. DATE TAGS/NOTES/CONDITIONS
Q Building
O Flry Marshal
O Parmit Tech (OTC permit only)
hit1'?/`/wwvv,co,mason.wa,Lls/GGrnillunlry—d v/ Rev:3/09/2017