HomeMy WebLinkAboutBLD2007-00426 Final Replace Roofing - BLD Permit / Conditions - 6/28/2007 E COMPLETED IN MASON COUNTY PE€zMIT N6.AO d a
69.
FORM MUST B PLEASE PRESS HARD 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 INFORMATION CONTRACTOR INFORMATION
Owner el um C 1U l t'_Q e�®n Company NameA401"d i el CU'ay t{L Tina
Mailing Address P O SQ% 9 C k221 Mailing Address P D Px-!sx 144 Q
CityE;Ce=ar ften StateS.DQ Zip Code q` "�, i Cityp�f rmc.rlx= State Lc 9 A Zip Code��
Phone'2560 440 t49t7;Q Other Ph21bQ!140 `b5145 Phone?"r) ' c?Q Q_5 6!5 Other Ph.
Lien/Title Holder Contractor Reg. Exp. I
E mail address E Mail Address aucki ut
Drivers Lic.# DOB Drivers Lic.# A, 4 DOB 1 Q-f�►-�(�
SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic f?S
Connect to Water System _Name of Water System as-MA s L OA F_
Well Sewer System Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No. 1 a 2?3 5►Q 0 0 -7`7 Fire District
Legal Description �� D"�°� °'I I-V-r 77
Site Address (Please include street name, street number and city)�i ��� �� Cy R►� l fit` �` �-�
Directions to site L. l.•
1. -F
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 action?Yes/No
TYPE Of JOB - New Add Alt Repair' Other PRIMA RESIDENC SEASONAL ❑'
Use of Building -----Describe�. tWork
�_
No. of BedroomsNo. of Bathroom s —Squa Footage- 1st loor P.Ir,, 2nd Floor
3rd Floor — Basement 4A 40--Deck 1 G i Covered Deck Other 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.
re that I am the owner,owners legal representative,or the contractor. I further declare
Acknowledgement of such is by signature below. I decla
that I am entitled to receive this permit and to do the work as proposed in the application. I declare that I have obtained the permission from all
the necessary parties. If permission is required from any easement holder or any other party in interest regarding this application or the work
proposed in the application, I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or
agent on owners behalf, represents that the information provided is accurate and grants employees of Mason County access to the above
described property and structure 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 suspended for a period of 180 days.PROOF OF CONTINUATION OF WORK IS BY
MEANS OFAP GRESSINSPECTI N.INACTIVITYOFTHISPERMITAPPLICATIONOF180DAYSWILLINVALIDATETHEAPPLICATION.
X e �0 d1 Date: L -
Owner/Own rs Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date
DEPARTMENTAL REVIEW A PPROVED DEN IED NOTES l"..1
Bui
lding Department d
p
Planning Department
Environmental Health Department
Fire Marshal
FEES
Building Permit Fee Site Inspection
Plan Review Fee EH Review Fee
Plumbinq & Base Fee Planning Review Fee
Mechanical & Base fee
Other
Wood/Gas/ Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal
i Valuation $
TOTAL FEES
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-A business registered as a construction contractor with LEtl to perform construction work within the scope
of its specialty. A General or Specialty construction Contractor must maintain a surety bond or assignment
of account and carry general liability insurance.
License Information
i License NORDIS1180QA
Licensee Name NORDIC SERVICES INC
fr
Licensee Type CONSTRUCTION CONTRACTOR 3
t 600458809 Verify Workers Comp Premium
UBI Status
Ind. Ins. Account
Id
Business Type CORPORATION
Address 1 9618 MIDVALE N i
Address 2
City SEATTLE
County KING
State WA
Zip 98103
Phone 2065229570
Status ACTIVE
Specialty 1 GENERAL
I z
Specialty 2 UNUSED
Effective Date 11/1/1982
Y
x Expiration Date 1/1/2008
Suspend Date
Separation Date
Parent Company
Previous License PEAKERG192M
Next License
Associated
License
https://fortress.wa.gov/lni/bbip/Detall.aspx?License=NORDISI 180QA 3/26/2007
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CONCRETE MECHANICAL MANUFACTURED HOME
N '
C) Footings I Setbacks Gas Piping z
o irstuiorDate By ic�tertat-Da y, Date ay 0
Ext Date13y Exterior-Date � Set-ate - Z
Point Lead f Isolated Footings INSULATION - Date BYBG �
)date B r Da SLAB its L#i_A#iC�iU By FIRE DEPARTMENT T N
Foundation t Lis .
Floots i=3aie By
Date BY Data 8.y DECKS
JER-AWNG Walls Date By
-C> B at - Y _ PROFANE TANKS
PLUMBING vault $ mate By
-
aate OTHER
Groundwork attic
Date By Data Data ay
DRYWALL _ Type:
Inn Brad,Wail Date By W
Date - By RNAL WSPECTI +! _
(D Water'urea Fire eperatt t
O
m Ukatp 1AY Date By Date By O
m �
Pass or mu st Inspect. c
Type of Insp. Fail ��t� Date �� Comments N
_ -
lyo �i'/'fir- . �` J-
v
i
8
l
0
i
i
J
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03
o + ON,CRETE MECHANICAL MANUFACTURED HOME �
o "'� Z
o F ootin {setbacks Date BY:
rRilbbons m
0 lnteri Gnat By Interier-Date Bar By N
O
Exterior Date By Exterior-Date B t- _ Z
G�
Point Load t Isolated Pocatln INSULA11 N ate 'y
BG f SLAB INSULATION C
Date ByData FIDE DEPARTMENT to
Foundation Walls _ Floors Date By
Gate B Data ��' DECKS
FRAMING waft Date By
Late Rata By PROPANETANKS
PLUMBING —_ Vault- Data By
Dato By OTHER
raa+ f* ,attic
Date By Type:
Date �� lasts
DRYWALL
la.7u -V
Int Breve Wall Date By W
Date By Date
FINAL.INSPECTION N
v Water LineFireSep�erekl4n
Hate By Date By late By
ICI �
Pass or Request Inspect, o
° Type of Insp. Fail Date Date Dons By Comments �
in
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