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BLD2002-00830 Final ReRoof - BLD Permit / Conditions - 1/27/2003
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Sn' u) c _. .— ] U) ca 2 c O a) L (n W > .-. p.. ��-- D N n ,� H Un C O - c) to n 0 O p. a) O a) ,C O z O L p `o �n a> a nX 0 F Q3 L c E vi co zU 0jy L � �? c �u cu p c L W lU W O F- 1._ (n O .N Mz J > cu 0UU cp a) PUoj LU cVU z () U CQ w y A z0 a 5 Ecn 7 ? � � O 00 a III t- U) (1 -_ Y, E f3 N a v n LU 0 cn _L z C)a �_ 0 j� z C� J i rn I V Aq Flop Aq 2-< Flop A e LT NOLLOUSN1 lVNld our,J Aq amp' Aq oNIUVN auvoe-lVM 'A'M'O Al Flop L13H10 111W W � Al Flop Aq Flop A4 ONIMO Mf ld 'ld3a 3UM SPM Aq Flop Aq Flap A4 FuLd WooId Aq Opp HOLLV1f1SN1 Aq dfl leS AqFlee SPM Aq FIBp �!d!d�J Aq mjoqcrd Aq Flop 31MOH 3118 M lV'JWVFk)3m PERMIT NO.: BLD FORM MUST BE COMPLETED IN INK MASON COUNTY PLEASE PRESS HARD BUILDING PERMIT APPLICATION /,,,3G,0 2 OD/ ©1 `'3 426 W.'CedadP.O.Box 186,Shelton,WA 88684 Shelton 360 427-s67o Belfair 360 275114s7 CONTRACTOR INFORMATION 68 APPLICANT INFORMATION p ,�,dN Contractor Name _lf��Own � �� '2 Mailing Address Mailing Address v °� ���,t� State Zip Code i State l✓p Zip.Code R*.!c --- Clty Other Ph.(_� City A211 y Other Ph.(3�� ) Ph.L_--_J— Phonetic ),�7 - Contractor Reg. # Lien/Title Holder G✓l+rl✓/A`Test/ S Expiration Address e a Existing Septic�_Connect to Sewer SEPTIC/WATER SYSTEM I[NFORMATI"ON-Connect to New Septic Well � Water System Name of System Name of Sewer Systern Water System Fire District -s PARCEL INFORMATION-12 digit Tax Parcel No. Legal Description - ' —-d C'��rT .� `l 3 Site Address(Please include street Warne, street number and-city Directions to site Will timber be cut and sold in parcel preparation? (Yes/No)� Saltwater Is your property within 200' of the following: Body of Water (Name) Stream Slopes or Lake River/Creek Pond Wetland Seasonal Runoff Bluffs PERMANENT RESIDENCES SEASONAL RESIDENCE El TYPE OF JOB Neyv Add Alt Repair Other Use of Building Describe Work Gr RE FOOTAGE-1st Floor 2nd Floor No. of Bedrooms SQUARE No. of Bathrooms Deck Other sq. ft. 3rd Floor______Loft Basement__ Garage _Attached Detached rt Carpo __ Attached Detached I l Model Year Mode MOBILE OME INFORMATION-Make No. of Bedrooms No. of Bathrooms Lengt Width Serial No. Replacement Unit ?(Yes/No) Type e t Purchase Price $ Certification No. Install r Na e ZED IS NOT CED WITHIN 180 DAYS OR IF AUTH NOTI CE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTROU�TIF0180 DAYS AIT ANY TIME AFT ER THE WORK IS COMMENCED. CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERt on owner's PR the OOF OF CONTINUATION OF WORK and rants emEANS ployeeOF A s of MasOonRESS County accesslOto the above described property and strut tunes forrreviewts tand information provided is accurate 9 inspection of this project. Acknowledgment of such is by signature below: y that I am OWNER AFFIDAVIT-]certify that I am exempt from the reghuirements of e o dinance istered as a the o ONacRACtor n�e'State o Washingtonlfand that am awarle ofgthe ordinance . sued and all work 3 Contractor Registration Law RCW 18.27 and am aware of tk for requirements for which this permit iissue beand that all work made without first stl obtaining ng be done�n shall be done in requirements c conformance man a therewith.IcNohchangeis s shr is ill be made without conformance therewith. No changesfirst obtaining approval. approval. k X Date_ X Date 49� FOR OFFICIAL USE BEYOND THIS POINT �U r Date ubmittal Amount Due . Re Accepted by ceipt No. — 7771- D.f»P RT;MENTAi,.R Vi 1 PPRCtVED DEN1 0 777 oNDITIf;�N Building Department Occ Grou Type Constr. Planning Department Environmental Health Department Public Works Department Fire Marshal i Valuation $ FIDES 30 Site Inspection Budding Permit Fee EH Review Fee Plan Review Fee x Planning Review Fee Plumbing&Base Fee Other Sa Mechanical&Base Fee State Fee C Wood/Gas/Pellet Stove Fee ( `a ) Pre-Paid at Submittal Violation Fee TOTALFEES