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MINX Date By OTHER Date By DRYWALL Type: Date By Water LineDate By Type Date By Int.Brace Wall Date By MECHANICAL Date FINAL INSPECTION 1�0 j (D Fire Seperation CD Date(D By Date ay Date By 00 Q Pass or Request Inspect. Q 6 (D Type of I nsp. Fail Date Date Done By Comments CA — 57 �VCO AA*X HO&-?dr- 4 1A)L1,0VQ7K/ (D 0 o 00 0 3 _U (D 0 ..................... �a MASON COUNTY COMMUNITY SERVICES ' PERMITASSISTANCECENTER; Permit No: I ' •BOILDING•PLANNING•FIRE MARSHAL ry 615 W. Alder St-Shelton, WA 98584 Q C CEN E V Phone Shelton:(360)427-9670 ext. 352 Fax:(360)427-7798 , `G - — Phone Belfair. (360)275-4467 Phone Elma:(360)482-5269 pUG 3 120 1854 PLUMPING & MECHANICAL PERMIT APPLICAT10*5 VV. pNder Street OWNER INFORMATIO , CONTRACTOR INFORMATION: NAME: in 1 451a uIGI P��2 �.:. � MAILING ADDRESS: - l W � A MASON ENERGY LLC CITYS viq---1=t✓v ST TF�" ,}� ZIP: ZLS 1870 E AGATE RD-SHELTON,WA 98584 1 sc PHONE: W -yol 6 PHONE:360-556-8540 2nd PHONE: EMAIL: OUTDOORLIFE44@YAHOOO.COM EMAIL: MASONEL852LS exp: 6/10/2014 PARCEL INFORMATION: PARCEL NUMBER(12 Digit Number): 00 y U Zon ing:RR'-5 LEGAL DESCRIPTION(Abbreviated): SITE ADDRESS: CITY: DIRECTIONS TO SITE ADDR4ESS: Y Dai n Ct y 26—(--f- `-6 . TYPE OF JOB NEW ADD ALT REPAIR OTHER USE OF UILDING LOCATION OF FIXTURES/UNII1 sr FLOOR 2ND FLOOR BAS)AffiNT GARAGE OTHER PLUMBING FIXTURES(SHOW NUMBER OF EACH) MECHANIC L,UNITS Type of Fixture No. of Fixtures Fees Fuel Type:Elec c LPG Natural Gas Ductless Toilets Tyne of Unit No. of Units Fees( Bathroom Sink Furnace Bath Tubs Heat Pump Showers Spot Vent Fan Water Heater Propane Tank Clothes Washer Gas Outlets Kitchen Sinks Wood/Gas/Pell Stove Dishwasher Kitchen Exhaust Hood Hose bibs Dryer Vent Other Solar Panel Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL OWNER/BUILDER acknowledges submission of inaccurate information may result in a p work order or permit revocation. Acknowledgement of such is by signature below. I declare that I am the owner, owners le I representative, or contractor. I further declare that I am entitled to receive this permit and to do the work as proposed. I have obtained p ission 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 sus a ded for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PE MT TION OF 0 PDAYYS WILL VALIDATE THE APPLICATION. x Sign ure f Ap licant Date x Owner/Owners Representative/Contractor Print Name (Circle one) DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT FIRE MARSHAL Visit us on-line: http://www.co.mason.wa.us/community_dev/ Rey:!i ',''24': ,aN