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HomeMy WebLinkAboutCOM2013-00066 Final ReRoof - COM Permit / Conditions - 6/10/2013 Y w h X N CONCRETE MECHANICAL MANUFACTURED HOME Date w Footings I Setbacks Chas Piping By Ribbons as p Interior Date By interior-Date By now By z Exterior Date By Exterior-Date By Set-up Point Load lleoiatad Footings INSULATION o By Date By Date SLAB INSULATION By FIRE DEPARTMENT Foundation Wails Floors Date By Date By Data By DECKS FRAMING waft Date By Date By Data By PROPANE TANKS PLUMBING vault Date 8y Date By OTHER Groundwark Attic Type: Date By Date By Data By O»W.V DRYWALL Type: 0 Int Brace Wall Date By 3 Date By Date By FINAL INSPECTION p Water Line Fin Separation Date B // ` W Date By Date By y b p Pass or Request Insperct. Q Type of Insp. Fail Date Date Done By Comments /✓ C v m A O A 1 X i ) cn g0 § 2 \ \ . . . & {/ { \ ƒ > ( / ) M N > ` \ ] y > U) ( \ \ / 2 A \ > � \ ° ; $ gGG [ [ =r > 3 k \ 07 ) ) $ / § CA c " ® / _ \ 2 / \ % / 0 z ; f T ( \ ( / aQ J \ £ 2j2 \ / .. . 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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 IN RMATION _ CONTRACTORMf ORM JO Owner 19X Company Name { I& h !1 Mail"Addre s I 1 Mailin A^d�ress CityIjFZVIVI4 State Zip Code754)110 - ty fS State Zip Code Phone— Other Ph. Phone t&r Ph. Lien/Title Holder Contractor g GI f aS xp. dl�i E mail address E Mail Addre _ Drivers Lic. # DOB Drivers Lic. # DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System Well Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. O Fire District Legal Description Site Address (Please include street name, street number and city) V 1 Directions to site 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 �/o Is this permit submittal the result of a Stop Work Notice Correctio otice or other enforcement action?Yes/No TYPE OF JOB New Add Alt_ Repa Cher P I AR RESIDENCE ❑ SEASONAL ❑ Use of Building Describe Work No. of Bedrooms INo. of Bathrooms Square Footage- 1 st Floor 2nd Floor 3rd Floor Basement Deck Covered Deck Other Sq. ft. Garage Attached Detached Carport Attached Detached M FAC ED HOME INFORMATION - Ma Model Year_ ngth Wi Serial N o. No. edrooms N f Bathrooms Type of Heat Purcha rice $ Repla en Unit? s IN 0 Installer Name Certification o. 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 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 with days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANSOFAPROGRESSIN ECT ACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. x Date: lP - 10 — 13 Owner/Owners apresentative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Oafux Date I DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department Fire Marshal FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing & Base Fee Planninq Review Fee Mechanical & Base fee Other Wood /Gas/ Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES ( 2 l ! ƒ / - { \ \{ xy ƒ » x = me * ! 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