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Ln & - %�2§\\( \ ] � 0 -e § � � ■ § \ E .2r CL = ± % CL e CD ; /, x \ ) m �\ \ \\ \} \\ § ) T n CONCRETE MECHANICAL MANUFACTURED HOMEDate _ Footings I Setbacks Gas Piping By Ribbons X CIntenor Date By Interior-Date By Date By m OO Exww Date By Exterior-Date By Set_up at Point Load I Isolated Footings INSULATION Date By In Date By BG I SLAB INSULATION m Data By FIRE DEPARTMENT Foundation Walls Floors Date By (f� Date By Date By DECKS -77 FRAMING Walls Date By Date By to By Date TANKS By t PLUMBING Vault Date By OTHER Groundwork Attic Date By Date By Type' / Date V1 D.W.v DRYWALL Type By t InL Brace Wall Date By iF Date By Date By H FINAL INSPECTION m Water Llne Fire Separation / / 0 Date By Date By Dale (i By, o Pass or Request Inspect. c T Type of Insp. Fail Date Date one y Comments Cn f m N M O n 0 a M 0 N O S fll 01 N O v W Wf 6652 MASON COUNTY (360) 427-9670 Shelton ext.352 FCga_C.riL'lTF DEPARTMENT OF COMMUNITY DEVELOPMENT (360) 275-4467 Belfair ext. 352 BUILDING. PLANNING• FIRE MARSHAL (360) 482-5269 Elma ext. 352 Mason County Bldg. III, 426 West Cedar Street fau PO Box 279. Shelton. WA 98584 www.co.mason.wa.us FIR2(IO- Co-, I Mason County Fireworks Permit Application Incomplete ayolications will not be accepted A permit for retail sales or public display of fireworks is required. A completed application with required documentation and fees shall be submitted for Fire Marshal review. A permit will be issued upon satisfactory site inspection by the Fire Marshal. Applicant Information: Owner: DEE-ANN CHARTIER Mailing Address: 40 E TOTTEN PL City: SHELTON State: WA Zip: 98584 Phone#: 360-970-3615 Email: Ijsjcjrhijmtntfjrewnrkq mm Sponsor Information: Name: DEE-ANN CHARTIFR Address: 40 E TOTTEN PL City: SHELTON State: WA—Zip: 98584 Phone#: 360-970-3615 Email:lisicichl@tntfireworks.com Washington State Fireworks License Information (Copy Required): License Number: 16-0446 Date of Issuance 04/01/2016 ❑ Pyrotechnic Operator License ® Fireworks Stand License Bond or Certificate of Insurance (Copy of Certificate/Bond Required): Provider: SEE ATTACHED Insured: Certified Holder: Location of Stand/Display: " Site Address:_ I31 j E'yn wul� U-+'E 0 ,01 e L&yL_ Directions to Site: Parcel Number: (twelve digit number)32.0 31 - 11 - bOnrlO Legal Property Owner "Please see reverse side to complete your application" RECEIVED APR 282016 6i;i W. Alder Struct The following pertinent information MUST be provided on the site diagram below Location and Setback distances from the back, sides and front of retail sales stands or designated display areas to: Fire Hydrants Property Lines Mortar separation distance Combustibles Parking Designated landing area Fire Lanes Public Roads and Right of Ways Trees/Brush Private Roads and Right of Ways Utilities Landmarks SEE ATTACHED DIAGRAM Applicants Affidavit I certify "ate info ati n provided herein is accurate and that compliance with all County, d Fed ral aws pertaining to the sales or discharge of fireworks shall be main e Sigel OROUCH TIER Date 04/21/2016 II