HomeMy WebLinkAboutBLD2019-00280 Cancelled Heat Pump - BLD Application - 7/24/2019 Mar 26 19, 08:17p A&M HEATING 3608953335 p.2 �I
-� MASON COUNTY COMMUNITY SERVICES Permit No:
PERMIT ASSISTANCE CENTER: ' �cxa
+ +BUILDING +PLANNING +FIRE MARSHAL t j
615 W.Alder St-Shelton,WA 98584 RECEIED
�/
www.co.mason.wa.us
Phone Shelton:(360)427-9670 ext. 352• Fax-(360)427-7798 MAR 2 8 2019
Phone Belfair. (360)275-4467• Phone Elma:(360)482-5269
PLUMBING & MECHANICAL PERMIT APPLIMOONAIder Street
OWNER INFORA'[A'TION: CONTRAC It INFO ATLON:
NAME: C ott Ct�ti� NAME: lA
19
i MAILING ADDRESS: ' J
MAILING DDR SS•
CITY: STATE: WA ZIP: CITY t��G ATE:W ZIP: W�
l='PHONE: -•? - PHONE: ' S CELL:
2"d PHONE: f L EMAIL : ID e CG+rK
EMAIL: M r PS�Gt t vt 2R c. itn L&T REG# M Z E•XP. D l�% {�
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PARCEL INFORMATION:
PARCEL NUMBER(12 Dif#t Mim6er): �` _�^ 005D Zoning:
LEGAL DESCRIPTION(Abbreviated): ___.
SITE ADDRESS: ITY:
DIRECTIONS TO SITE ADDRESS: _
TYPE OF JOB:
NEW ADD ALT�REPAIR OTHER US OF UIL T
; OCATION OF FMIJRES/UNITS— I ST FLOOR 2YD FLOOR B MENT GARAGE OTHER
PLUMBING FIXTURES(SHOW NUMB ACH) ME NI AL UNITS
Type of Fixture No.of Fixtures Fees F el T- :Electric LPG Natural Gas Ductless
Toilets T e f nit No.o� f�Umts Few
Bathroom Sink:
Rath Tubs Zpot
ampShowers ent Fan
Water Heater an
Tank
Clothes Washer Gas Outlets
Kitchen Sinks Wood/Gas/Pellet Stove
Dishwasher Kitchen Exhaust Hood
-Hose bibs Dryer Vent
i Other Solar Panel
Other --� SO
Base Fee _ Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
OWNER acknowledge 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 permitfapplication becomes null 1£void
it work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days.PROOF
OF CONTI UATION OFTHIS PERMIT IS BY MEANS OF INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS
WILL INV lDA THE AP CATION. ,
iX -3Zsl � _
iSignature of Owner Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
Rev:1;27!2015 !BN
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