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06/17,12015 08: 42 3604277466 OLYtAPIC HEATING PAGE 01/02
r
MASON COUNTYPERMIT NO. LU �
DEPARTMENT OF COMMUNITY DEVELOPMENT
r' BUILDING.PLANNING&FIRE MARSHAL V Q
f WWW.CO.MASON.WA.US (360)427-9670 Shelton ext-352
Mason County Bldg. 111,426 West Cedar Street (360)275-4467 Belfair ext.352 r y�
v PO Sox 279, Shelton,WA 985D4 360 482-5259 Elma ext.352 , iD
PLUMBING & MECHANICAL PERMIT APPLICATION JUN 17 2015
OWNER.FORMATION: CONTRACTOR INFORMATION: S T,.
NA.ME:-`- �-( � A i, I rf�r�ry NAME• _
MAILING ADDRESS: r f C& MAILING RESS:
CITY _l f-crU STATE: l^f A ZIP., STATE: �,jR ZIP.
PHONE;3r�-�5-7 CELL:: PHONEi -R94-5CELL:
EMAIL: EMAIL : nh c �tSly.Co
- L&I REG �t m Q4 4&_Q f, 4 EXP.J l /�
PARCEL INFORM, ]:k0N:
PARCEL NCJNMER(I2 DIGIT NUMSER):(4,2Q)2-52 c7<--�1025
LEGAL DESCRTPTI0N('4BglttirL4TE1)): R-3-'rK_Lop::�i'
SITE ADDRESS:10 E Pack 0 GC2 cr :;hel fi�- -
DIRECTIONS TO SITE ADDRESS:
TYPE OF JOB
NEW ADD ALT REPAIR OTHER USE OF BUILDING
LOCATION OF MT'URES/UNITS-15T F2.06R 2r�)FLOOR BASEMENT GARAGE OTHER
PLUNMING FDTrnES(SHOW NUMBER of EACH) MECHANICAL UNITS
T vne of Fixture No.of Fixtures Fees Fuel Type:Elec 'c LPG Natural Gas Heat Pump_
Toilets Type of Un_it No.of Units Fees
Bathroom Sink. _ Furnace
Bath Tubs Heatpump
Showers Spot Vent Fan
w 'Water Heater Propane Tank —_
Clothes Washer _-- --_ ._. Gras Outlets
Kitr..h.en Sinks Wood/Cras/i°ellet Stove
?��s;awasher _ Kitchen Exhaust Hood
li�sehibs Dryer Vent
Other- Other
Base Fee Base Fee
TOTAL PLUMBING _ _ - TOTAL MECHANYCAL
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 entitied 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
permitlapplication 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
PERM[T APPUCATlON-o YS WILL INVAI. DATE THE APPLICATION. ) f
X
Sigriature rcant Date
X Own rfQwners Representar$v6ACa6tracY
Print Name (indicate which one)
Y TPit
�fy ZR'i9S'L LC G �
137U-DING DEPARTMENT
PLANNING DEPARTNIENT
FM MARSHAL,