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Inspection Line(360)427-7262
MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670, ext.352
Mason County
615 W Alder St
Shelton, WA 98584
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Issd RESIDENTIAL BUILDING PERMIT
BLD2017-01194
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OWNER: DEANNA CLAUSSEN RECEIVED: 12/7/2017
'9 CONTRACTOR: HOME DEPOTAT HOME SERVICES 800-381-5699 LICENSE: HOMED**972RQ EXP: 2/3/20' ISSUED: 12/7/2017
SITE ADDRESS: 11 NE LANYARD CT BELFAIR EXPIRES: 6/7/2018
PARCEL NUMBER: 123305100070
LEGAL DESCRIPTION: BEARDS COVE DIV 4 LOT: 70
DIRECTIONS TO SITE:
PROJECT DESCRIPTION: S
RE-ROOF PERMIT SFR ST RT 3 TO BELFAIR, L ON ST RT 300/NORTH SHORE RD, THEN RIGHT
ON LARSON LAKE RD TO LANYARD CT
General Information Construction&Occupancy Information Square Footage Information
No. of Bedrooms: Type of Constr.:
Type of Use: SF Insp.Area: No. of Bathrooms: Occ. Group: Lot Size: Deck:
Type of Work: RR Fire Dist.: 2 No.of Stories: Occ. Load: Building:
Valuation: I Building Height: Occ. Status: Basement:
I
Manufactured Home Information . Setback Information Shoreline&Planning Information
Make: Length: Ft. Front: Ft. Shoreline: Ft. Water Body:
Rear: Ft. Slope: Ft. SEPA?:
Model: Width: Ft. Shoreline Desig.:
_ Side 1: Ft.
Year: Serial No.: Side 2: Ft. Comp. Plan Desig.:
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Building State Fee GMM 12/7/2017 $4.50 S1201700000001
Re-Roof Fee GMM 12/7/2017 $ 117.50 S1201700000001
Total $122.00
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BLD2017-01194 Please refer to the following pages for conditions of this permit. Page 1 of 3
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MASON COUNTY PERMIT NO. CI Pt)o -a l/4�4
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''= Company Name THE HOME DEPOT
Mailing Address PO BOX 342 Mailing Address 3600 LIND AVE SW#150
City BELFAIR State WA Zip Code 98528 City RENTON State Wa Zip Code 98057
Phone 360-908-0813 Other Ph. Phone 800-381-5699 Other Ph.
Lien/Title Holder Contractor Reg. # HOMED**088RH Exp. 7/17/2018
E mail address E Mail Address naida@nwpermit.com
Drivers Lic.# DOB Drivers Lic.# DOB
j 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 12330-51-00070 Fire District
Legal Description
Site Address(Please include street name, street number and city) 11 NE LANYARD CT.BE:FAIR WA 98528
Directions to site WA-3 NORTH.Turn left on NE Old Belfair Hwy. Left onto NE SR 300. Right onto NE Sand Hill Rd. Left onto NE Larson Blvd.
Left onto Lanvard Ct.
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 X Other PRIMARY RESIDENCE Q SEASONAL ❑
Use of Building residential Describe Work Replace 12 squares comp roofing. Replace 5 squares plywood.
No. of Bedrooms No.of Bathrooms Square Footage- 1 st Floor 2nd Floor
3rd Floor Basement Deck 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.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 accu and grants employee unty access to the above described property and structure for review and inspection.
A770N WOR IS B OF A PROGRESS INSPECTION �� y
Date:
r/Owners Re ive/Contractor indicate which one
FOR OFFICIAL USE BEYOND THIS POINT Accepted by:OWU Dat 17
DEPARTMENTAL REVIEW APPROVED DENIED 4 NOTES
Building Department
Planning Department
Environmental Health Department
Public Works Department
Fire Marshal
FEES
Building Permit Fee Site Ins ection
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
Home Depot Contractor License Numbers:
WA:HOMED088RH,MOOREJR934LN
Salesperson Name and Registration Number:
Randall Larkin : R-1-128533-15-01677
Home Improvement Agreement
Home Depot U.S.A., Inc. ("Home Depot") or Service Provider named below will furnish, install and/or
service the equipment listed below at the price, terms and conditions as outlined on this form.
Customer Information:
Deanna Claussen Seattle 10549189
First Name Last Name Branch Name Lead#
11 NE Lanyard Ct BELFAIR WA 98528
Customer Address city State Zip
E6�) 908-0813
Home Phone# Work Phone# Cell Phone#
deannaclaussen@yahoo.com
Customer E-mail Address
NOTICE OF RIGHT TO CANCEL: YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR
OBLIGATION BY DELIVERING WRITTEN NOTICE TO HOME DEPOT AT:
3600 Lind Ave. SW Suite 150 Renton WA 98057
Address City State Zip
or Email CustomerCancellationWest@homedepot.com
BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING, UNLESS THE STATE
SUPPLEMENT PROVIDES A different CANCELLATION PERIOD. THE STATE SUPPLEMENT
CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN YOUR STATE.
YOUR PAYMENTS) WILL BE RETURNED WITHIN TEN (10) BUSINESS DAYS AFTER HOME
DEPOT'S RECEIPT OF YOUR NOTICE. YOU MUST MAKE AVAILABLE FOR PICKUP BY HOME
DEPOT OR PROFESSIONAL, AT YOUR SERVICE ADDRESS, AND IN SUBSTANTIALLY THE SAME
CONDITION AS WHEN DELIVERED, ANY MERCHANDISE OR MATERIALS DELIVERED TO YOU.
OR YOU MAY CONTACT HOME DEPOT FOR INSTRUCTIONS REGARDING RETURN SHIPMENT AT
HOME DEPOT'S EXPENSE.
THE LAW REQUIRES THAT THE CONTRACTOR GIVE YOU A NOTICE EXPLAINING YOUR RIGHT
TO CANCEL., PLEASE SIGN BELOW TO ACKNOWLEDGE THAT YOU HAVE BEEN GIVEN ORAL
AND WRITTEN NOVICE OF YOUR RIGHT TO CANCEL.
Acknowledced by:
11/30/2017
XCustomer`s Signature." -- - -'"' Date
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