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I
fe�A ox Boa a MASON COUNTY COMMUNITY SERVICES' permit No: I -0d q�b
PERMITASSISTANCE CENTER:
•BUILDING•PLANNING•FIRE MARSHAL
615 W. Alder St-Shelton, WA 98584
t` Phone Shelton:(360)427-9670 ext 352 Fax:(360)427-7798
Phone Belfair. (360)275-4467 Phone Elma:(360)482-5269
PLUMBING & MECHANICAL PERMIT APPLICATION
OWNER INFORMATION: CONTRACT R INFORMATION: ZZZy
NAME: NAME:_01
MAILING AD S�3¢a W rp' Ie4 MAILING AIbDRESS:S3 -1 � S a 4--
CITY: Sal ► STATE:W/•'r ZT:q YE CITY: She_4-n STATE: WA- ZIP:9 IT&
I"PHONE: 3(,0 - 467- U3 2.( PHONEIA-,426- 4 l46 CELL:
2nd PHONE WJ ?6 0-4 26-4 4 3 3 p 5 Lf 2( EMAIL :
EMAIL: 9 ��.�c�1, lr�c�@ y� o o , (,./►� L&I REG#DLY/K PPA &8'?0 EX-P.
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number): i''L-O O 1 Ll-�2 0 6 Y/ Zoning-
LEGAL DESCRIPTION(Abbreviated):
SITE ADDRESS: 3380 W / R- CITY:
DIRECTIONS TO SITE ADDRESS: 'v f+- -�-
rn iJ' �+ o.J- rr...: a i 6 {.►hd
TYPE OF JOB
NEW ADD ALT V REPAIR OTHER USE OF BUILDING
LOCATION OF FIXTURES/UNITS— 1sT FLOOR 2"DFLOOR BAS NT GARAGE OTHER/
PLUMBING FIXTURES(SHOW NUMBER OF EACH) MECHANIC UNITS
Type of Fixture No. of Fixtures Fees Fuel Type:Elec 'c LPG Natural Gas Ductless_
Toilets Type of Unit No.of Units Fees
Bathroom Sink Furnace
Bath Tubs Heat Pump
Showers 6 Spot Vent Fan
Water Heater ,` Propane Tank
Clothes Washev 160 Gas Outlets 4 h b•20
Kitchen Sinks Wood/Gas/PeIl IStov 7a—
Dishwasher Kitchen Exhausl Hood
Hose bibs Dryer Vent
Other Solar Panel
Other 7
Base Fee Base Fee lZa
S.SDTOTAL PLUMBING TOTAL MECHANICAL 0 . 70
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 into ation provided is
accurate and grants employees of Mason County access to the above described property��nd structure(s)for review and nspection.This
permit/appiication becomes null&void if work or authorized construction is not commenc within 180 days or if construc ion work is
suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY BEANS OF INSPECTION.INACTA ITY OF THIS
PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
x 9
Sigi(aturo of Applicant Date
x C'Cui • rl owrie wners Representative/Contractor
Print ame c one)
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
Visit us on-line: http://www.cp.mason.wa.us/community_dev/