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HomeMy WebLinkAboutCOM2004-00086 Final ReRoof - COM Permit / Conditions - 5/18/2004 � 0 - . @ I CD / a) f 0 a o / ƒ ƒ % % / % 0 m a ¥ efJ § \ 2 O \ c \ ® E ¢ rn / J CD c / & \ § f ® o g z > ; .. . m o Q o \ / 0 k q CO > \ = 2 2 � ; 2 CD3 \ \ > \ CO 2 (D § ƒ m \ mmaz / \ D \ \ / 3 2 3 \ c ] z / \ / \ ƒ \ in j - ; 0 ± ) 0 E \ ~ \ / / \ \ / / ] CD ® \ 2 / / G Z @ 0 ® * ® U) / \ \ / / % - 9 9 I ƒ 0 = \c } ƒ 2 \ m / \ 2 ( C 3 / ] 2 � @dX � Z m w a m # 0 / 2 / 0 \ _ \ -< / 9 © \ m ; } ( C Z 0 . \ O E J � CDm w 2m ® 0 20 0 3 p 0 71 2 2 � E ' 0 0 CD � q m x $ 2 � \ m m _0 7 0 Oe o D C . m2 r Z_ \ X cn D 0/ m ƒ � q 9 A / � m / .0 Z » z 0 § > / ° � \ \ & $ ® \ < & 7 \ 9 f ) } @ I@ & 2 0 O z > a a ° & v « a G / q � R G g R 9 m + (D G m \ / m / f7 � q 8 m _ I E ° - & � m Z 2 ® x ° ƒ m 3 © 0 \ 2 m 90 0 « m / e / \ 2 2 c x 2 » \ / 2 \ O \ \ 7 \ ° ° 0 < m o j \ $ k E g G = _ I z 2 / ) _ E .. \ .. 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Box 186, Shelton, WA 98584 Shelton (360) 427-9670 • Belfair (360) 275-4467 a Elma (360) 482-5269 On the web www.co.mason.wa.us APPLICANT INFORMATION CON RACTOR INFOR ATIOJV Owner , Al CA QV Company Name GaFL nofCf1 Mailin Addres 10 G 5i&, G°r Mailin Address 1 City � State f,,-*Zip Cod City State C— Zip Code Phone �� �7��a3 Other Ph. Phone3b0 a7S— }/ Oth r Ph. Lien/Title Holder Contractor Reg. HIJQ.-Af-& V Exp. E mail address E Mail Address Drivers Lic.# DOB Drivers Lic.#(Q DOB /�114) SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System Well Water System Name of Water System PARCEL INFORMATION - 12 Digit Parcel No. Fire District Legal Description Site Address (Please include §treet name, street number aLnV city) D i reSp9Ds,to site �'" r' Will timber be cut and sold in parcel preparation?Yes/No Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement qq1 on?Ye o TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE SEASONAL Use of Building (7Fr%C 151 Describe Work No.of Bedrooms No. of Bathrooms Square Footage - 1 st Floor 2nd Floor 3rd Floor Basement Deck Covered Deck Other Sq.ft. Gara a Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make Model Year Length Width Serial No. No.of Bedrooms No.of Bathrooms Type of Heat Purchase Price$ Replacement Unit? Yes/No Installer Name Certification No. 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 the contractor.I further declare that I am ntitled to receive this permit and to do the work as proposed in the application.I declare that I have obtained the permis- sion from all th s parties.If permission is required from any easement holder or any other party in interest regarding this applica- ion or the work p pos in the application, I have obtained permission from them to apply for this/permit and conduct the work proposed. X Date: Y Owner/Owners Representative ontract r (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Planning Pd Ck# Date Bld Pd Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department Public Works Department Fire Marshal FMS uildin Permit Fee Site Inspection l an Review Fee EH Review Fee .umbin & Base Fee Plannin Review Fee echanical& Base fee Other ood/Gas/Pellet Stove Fee State Fee olation Fee PrePaid at Submittal aluation $ TOTAL FEES MASON COUNTY PERMIT NO` (jjru(T'!- c uo BUILDING PERMIT APPLICATION ' 426 W. Cedar • P.O. Box 186, Shelton, WA 98584 Shelton (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269 On the web www.co.mason.wa.us APPLICANT INFORMATJOR CONTRACTOR I ORMATION Owner Company Name ljr►l 4tC oO�tI'� Mailin Add d G iS5-, Maili Address •U• X gicil City t State WA Zip Cod City I ►e, State � Zip Code V i f�'hhone 3CcD �75la3 her Ph. Phone3 - Oth r Ph. Lien/Title Holder Contractor Reg. U (o Exp. " Email address E Mail Address Drivers Lic.# DOB Drivers Lic.#6 DOB SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic i Connect to Water System Name of Water System Well Water System Name of Water System 001-70 PARCEL INFORMATION - 12 Digit Parcel No. Firp District, Legal Description Site Address (Please inclu a treet n , street numb, r city) i Direc to site /'CS G. k 1ro­tt4- m� t-e-41-S Olt ti Will timber be cut and sold in parcel preparation?Yes/No Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% Is this permit submittal the result of a Stop Work N fiL _ePfi0p4ktiCe e r a TYPE OF JOB - New Add Alt Repair Qtrer RI Y. SIp EEI�IGE SE SO AL Use of Building dF; E '9� Describe Work �J A GFf- No.of Bedrooms No. of Bathrooms Square Footage�l- � I 2 F oor 3rd Floor Basement Deck Covered Deck ther Sq.ft. Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make Model Year Length Width Serial No. No.of Bedrooms No.of Bathrooms Type of Heat Purchase Price$ Replacement Unit? Yes/ No Installer Name Certification No. 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 the contractor.I further declare that I am ntitled to receive this permit and to do the work as proposed in the application.I declare that I have obtained the permis- sion from all the cessa parties.If permission is required from any easement holder or any other party in interest regarding this applica- tion or the wor r pos n the application, I have obtained permission from them to apply for this permit and conduct the work proposed. X Date: C Owner/Owners Representative ontract r (indicate which one) j FOR OFFICIAL USE BEYONDTHIS POINT { Accepted by: Planning I'd Ck# Date Bid Pd Receipt No. 1, DEPARTMENTAL REVIEW QENIED NOTES Building Department Planning Department Environmental Health Department E Public Works Department { Fire Marshal bbb FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing & Base Fee Planning Review Fee Mechanical & Base fee Other i Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation$ , TOTAL FEES