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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 MARY REIFEL Company Name THE HOME DEPOT Mailing Address 171 NE BELFAIR MANOR DR Mailing Address 3600 LIND AVE SW#150 City BELFAIR State WA Zip Code 98528 City RENTON State Wa Zip Code 98057 Phone 206-354-5378 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 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 12330-75-90093 Fire District Legal Description Site Address (Please include street name, street number and city) 171 NE BELFAIR MANOR DR,BELFAIR 98528 Directions to site WA-3 NORTH.Tum left onto NE Old Belfair Hwy. Take the 1st left onto NE State Route 300/WA-300. Riqht onto NE Sand Hill Rd. Left onto Belfair Manor Dr. 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 ❑✓ SEASONAL ❑ Use of Building residential Describe Work REROOF:REPLACE 29 SQUARES COMP ROOFING.NO 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 oth in interest regarding this application or the work proposed in the application,I have obtained permission from them apply for this per ' and condu the work proposed. The owner or agent on owners behalf,represents that the information proyicla dfs.,accurate a d' rants e to ee of Maso o my ss to the above described property and structure for review and inspection. OOF OF 6-OnINU O BY A F PROGRESS INSPECTION.01 Date 1 W . Owners Re tat—we/Contractor indicate which one FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department Public Works 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 Home Improvement AgroSt n ant Home Depot Contractor License Numb*m: 5243fj�(;A Wrj31,GT AK-250PA AL 45878,1924,V"2,24752,03010,2302,51269AZ `,2, R00092581,Ro '� 420214 CM1440,CGC1514813,(-ACI813767,GFC1426021, ROCiX)057�V,f 000109,FL EC ,, R80AW5738 HI:CT-22120.CT 284M,C30,306.10-3662,005190,RCE-19683,230,;, )235N,0 2 1j24,87-11 2W 4 0204W� 1144-01-44 058-169244e 104017473,ChwAgo TGM26U;MA' 104510, 112786,107774,,MD�8!�l 4,05-421441 0,,-42144-01-46,W 4-�- Of�-76141-01.11589,7OW7,;W 147263,BC638192,PC147M3,PM-093715,f-1M-4V-`fi&NJ- 13\rt"2715t10-Ny'WftUCt*4tef[: Ifoy x Rhode eg* WC18484HWOH-4M2-OR-$558, 11827.95843;R6 Regt~ A� M SWId od Rd*idwftl('Oflt(e� R ty TACLA1574C,TACL814;8 ,TECL-24"7, ME137170, TJC113,M36192-M164 1, TFdC TRC-8936,WI419,5.Maxtor PBumbefLicons*M,64SIliJT-280*-.WSWI,VA 2706--,',,.i841XWV via#http;/IwwwhomedoW,toWd3V-,HS-,Contractx,-Lxww-NUMbOm for VW 40M 1`08n,e W; Salesperson Name and,Registration Numbir:-, Home Depot U.S.A., Inc, ('Home Depot')or Service Provider av ad below will furnish, install and/or service the equipment listed below at the price, terms and cond&:-ns as outlined on this fdrm. Customer Information: I fSeattle .......... NQT!CE--QE_Rj9_qT_TQ CMCfj,; YOU MAY CANCEL THIS AC REEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO HOME D,SPOT AT: 3600 Lind Avenue SW, Suite 150 Renton k'1A 98057 AM or Email CuStomerCancellationWest@homedepot.corn BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTEF SIGNING, UNLESS THE STATE -SUPPLEMENT PROVIDES A different CANCELLATION PI.:RIOD. THE STATE SUPPLEMENT CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRE-.1CRIBED BY LAW IN YOUR STATE. YOUR PAYMENT(S) WILL BE RETURNED WITHIN TEN (I�)) BUSINESS DAYS AFTER HOME DEPorS RECEIPT OF YOUR NOTICE. YOU MUST MAKE -0JAILABLE FOR PICKUP BY HOME DEPOT OR PROFESSIONAL, AT YOUR SERVICE ADDRESS, {'AND IN SUBSTANTIALLY THE SAME CONDITION AS WHEN DELIVERED, ANY MERCHANDISE Of; MATERIALS DELIVERED TO YOU. OR YOU MAY CONTACT HOME DEPOT FOR INSTRUCTIONS REGARDING RETURN SHIPMENT AT HOME DEPors EXPENSE. THE LAW REQUIRES THAT THE CONTRACTOR GIVE YOU A 40TICE EXPLAINING YOUR RIGHT TO CANCEL PLEASE SIGN BELOW TO ACKNOWLEDGE THAT YOU HAVE BEEN GIVEN ORAL AND WRITTEN NOTICE OF YOUR RIGHT TO CANCEL. Awawwh.tp.d by: ci ns Contract R1' Q�# h t#4 . P�-iynient of the contra t Writ~o i dart t po i, cx)mplettr�n ��nte e different paymont schedule Is specified in the Sttato Pall a apl r rat►le di a tattrrts, robAlos, tartrf , taxca t � �xctuciert firtrartr,{r chrar��tr.` COMM(Price Minimums "� depoit ....v Due Irnrne(iiatel�' Romaining balanc o $ ? , mute utx)n c;orr+piption Fini tnMiGh M, "Any Interest payments or other finance charges will be detorminl)d by Customer's uin add titan t ra e c polder or loan agreement, to which The Home Depot is NOT a party, a, (I will payment under this Agreement. Customer is subject to the term.,; and conditions of the cardholder or rvlce loan agreement, as applicable. No funds should be made payab o to Service Provider; Provider may collect Customer's paymont(s) made payable to Ti7-i Home Depot. Insurance proceeds will will not� be used to pay some or al 1 the total amount of sale. Pool Installation of _.�._� - -L A more detailed description of the work to be performed is incluc rod in the section entitled Scope of Work which appears on page -of this Agreement. Approximates Finish Date: Approximate Start Date: v_1, f _.,� inclement All dates are approximate and subject to change n on nce cc:verra e of Your claiunfor-,�seen events m for any pair, if weather, permitting delays, and delays in confirming i nnsure r applicable. g se, if E tic_Re s�rtE Q : You are entitled to a paper <.;opy of this Agreement if you choo you consent to an e-mailed copy, your consent applies to this Acf°eement and all subsequent documents may and written communications related to this agreement. By contacting your Service rvi Agreement or related update your email address, withdraw your consent, or obtain a spar copy r ou confirm documents at no charge. By providing your consent and verifying your email address above, y that you have access to a computer that can receive and open e,iiails and PDF documents. By Initi ling this paragraph, I consent to receive only electronic ro,;ords related to this transaction. initial y , , nitial LQ9;By signing below, you authoriza Home Depot to (a) arrange for Service r(b)order and arrange for thu delivery of special order merchandise, Provider to perform Installation and/o including special order merchandise that may be custom made.a;;specs#led in this Agreement. Do not sign if blank or incomplete. (Service providees/permitting information nay need to be provided to You later.) By signing, you acknowledge that you have read, understand, arid accept this Agreement in its entirety, including the General Terms and Conditions and State Supplement, if any. You further acknowledge receiving a complete this Agree ent. Keep it to protect your legal rights. !1 X S #`i a S0009fM at wit Prodw" $ -- - -Y Job* ?ef aver.a dM ] S tr uieDon awft t3utters t co v eKsry Entry 00or. C _ w4r tnsula Wn r Covert Tatsl Contract ._ Amount ' The warranty on the work identified above is listed In tha Gen®rai Terms anc; :onditior►s.or if aPOCObla,s ;n the fc 4kmhV dowments. Warranty Nan*s): The Home Depot General Torm* ,I,, Conditions 1, D-EFINIT10ms- youoryour means the customer identified iii the Agreement, 'Home DOPOt" means solely that legal entity identified in the Agreement as the Contractor, and none of its Llfflliate5, subsidiaries, parents, agents, representatives, employees,offikfls, managers or directors, "Service Provider" means an independent contractor authorized by Horn, Depot, and the Service Provider's employees, agents, subcontractors, and any others for whom th I Service Provider is responsible `Home' means the real property,fixtures and any physical imps ovements where the Services are performed. "Agreement* means the Home improvement Agreen ient between You and Homo DePOt, plus (1) any Change Orders; (2) the State Supplement, if any; these General Terms and Conditions {General Conditions*) and any documents referenced in or atta,,hed to any of the foregoing. 2. $,CO P p of goods, equipment, materials, and Q -The Agreement is for(1) the delivery and furnishint hardware and (2) any related labor and services, including witticut limitation. construction,consultation, fabrication, erection, installation, inspection, maintenance, repzs-,-, and testing (collectively, "Services"), as more particularly described in the Agreement. Home Depot may perform Services directly or May arrange for Services to be performed by a Service Provider. Notwithstanding any language to the contrary in any other portion, provision. or term of this Agreeml�it, Home Depot does not provide. authorize, or arrange for architectural, engineering or other liccrsed design services, nor does Home Depot provide, authorize or arrange for structural changes to Your Home. Services in 3- H0MF_j0�EpDT�$�RE$P1M$jMLqjE,%Home Depot or Serce,,' Provider will complete the - a workmanlike manner and in accordance with applicable law without causing damage to your Home, provided, however, that Home Depot or Service Provider will r.:)t start or continue with any services upon discovery of any condition at your Home that Home Dep.,t or Service Provider deems in its Solore discretion to be hazardous or unsafe. Unless specifically contra;led to do so, neither Home Dec)&n Service Provider is obligated to repair such pre-existing hazarck)us or unsafe conditions at your Home- 4. A-S,51GNMENIT/ CTLNC this Agreement. 2;Home Depot and Sertice Provider may assign oc-C or any right herein, or any monies due or to become due herett ider, and may delegate or subcontract any obligations or Services hereunder without Your consent. TI-is Agreement shall not be assigned by You without first receiving Home Depots written consent,whist" may be denied in Home Depot's sole discretion. 5. YO J lJR RE$PQN"l MTjM- terms a. Payment: You agree to pay Home Depot in full for the Servi jas pursuant to the te s of this is Agreement. to provide Home Depot and Servicz-, Provider safe and complete access b. Safe Access: You agree including any means of egress or ingress, and access to any property, ("Safe Access")to Your Home, i the staging, temporary s-�-.)ring and performance of the Services buildings, or structures necessary for the fol owing: (1)obtaining in advance of the ("Work Area"). Safe Access includes,without limitation, ements, restrictions, or other legal Services consent, permission, or relief from any covenants, eE s encumbrances affecting the Work Area-, (2) providing the localitan of utilities, whether underground, visible, to Home Depot or Service Provider; (3) removing from the Work concealed, overhead or v � Area physical impediments, hazards, and building code or zor ing violations that affect directly or indirecey the Work Area; (4) removing unsafe working conditions and hazardous materials, including Service the Work Area; (6)providing sanhary facilities to Home Depot or environmental hazards, from (or,SftenVMV4;y,payj%for",rental.00".O."f such facilities); Provider convenient to Wont Am -A w. The Home Depot General Terms 8. Conditions (6) providing all utilities, including without limitation, power, water, ventilation and climate control, in and for the Work Area; (7) removing from and protecting agains* "ninors, pets, guests and visitors in the Work Area, (g) keeping permits, if required, visible at all time":; (9) disengaging, suspending or terminating any security systems protecting the Work Area; (10) providing adequate temporary storage spaces as needed for Home Depot's or Service Provider's perfor-tance of they Services; and (11) not interfering, impeding, impacting or otherwise disrupting the Woe,( Area at any time during Home Depot`- or Service Provider's performance of the Services. c. Services are to be performed by Home Depot or Service Prm`der. If You attempt t Yourself and erform or assist with the Services in any way, You assume all risk for property d .mage and for injury to others. 6 t��?.DIfr�trAT[QN:�.ANQ�HA��-�..�.RQ�F�S�Without invalidating this Agreement, You may authorize cope of the Agreement (`Change Home Depot or Service Provider to perform Services beyond tt o s behalf of Home Work"). A Change Girder shall be issued by Home Depot or Seo,ice Provider on rt Depot, � which You may accept by signing. Upon Your signing of the Ctiv�nge Order, it shall become pa Agreement, subject to all of the terms of the Agreement. Changi)Work may also result from Home Depot or Service Provider encountering conditions at the Work Ares that impact, impede or otherwise interfere with the performance of the Services, requiring an increase in cost, time, or both. Following the discovery of any conditions that impact, impede or otherwi�F! interfere with the performance of the Services (including, without limitation, the following: previou:,ly undisclosed or unidentified legal encumbrances in the Work Area, building and zoning code violations, concealed and unforeseenroots, physical and hazardous conditions,the presence of undergrou--d or overhead utility lines, rocks, Home buried debris, mold, asbestos, lead paint,or any condition differing from what You represented),Depot may immediately ask for a Change Order or discontinue the Services without further obligation to You. If You decline a Change Order request, You or Home Deix-t may terminate this Agreement as set forth below. 7 CRE-D- C-XH mT� t�r�t ;If payment is made by crw.dit card, Your cardholder agreement,to which Home Depot is NOT a party, will determine the total cos:of Your purchase, including any initial paymenttdeposit You may make and all interest charges and floss. You will be further subject to Your cardholder agreement's terms and conditions. g- FINA ^TRgA A T (1t ; if You are financing this tran!3,Iction in whole or in part, Your separate loan agreement, to which Home Depot is NOT a party, will determine: (i) the amount financed or the sum of the credit extended; (ii)the associated finance charges -or the dollar amount the oYou an !will be ll Cost You; and (iii) the total payment--or the amount paid upon maLng all scheduled payme further subject to Your loan agreement's terms and conditions 9- TIT -E..A.N"L5K IQB$;The title to and risk of loss for Yrny materials or goads provided to You that originate from Home Depot(1) shall pass to You when paiA for in full by You or (2) shall pass to You when paid for in full by the Service ail pass to You upon cc�r�npletion of the Servicesrovider as part of the Services. Title to any hec materials or goods provided by Service Provider 0. )NA RRA TY A,N.Q_UMJ-TAT14N 0l9_WARR&NTIE the a. Warranty: Unless other war stated one Warrantye section r�_^pletiongdate that all Sement or in hrvicestshall be Supplement, Home Deno 'Cww 14M40-2 1l NMr�,t3so��3�35! a r s a The Home #pot General Term$ N ondltlons ed with oa�d workmanship and shall conform to the req ; rements of the A grind and A* 0f act perform g shall be any Services that are found not to be as warranted. Dung the warranty p at its sole a reasonable time after receiving notice from YOU of a warranty claim, Herne Depot may, Lion a correct or replace each Defect, or (b) remove each Di=''ect and refund the full p(Irchase pror ice thereof to You, Provided, however. that all warranties are voile,-` if anyone or Services thor than provided Home DOunder Service provider performs work upon or otherwise modifies and, nateria s LY this Agreement: b, Limitation an Warranties: THE WARRANTIES PROVIDED 1f THIS AGREEMENTARESUBPARAGRAPH STRII A�IN LIMITED TO THE FOREGOING EXPRESS WARRANTIES COO, T NPN THE/STATE SCIPPLEMI=NT� IF THE WARRANTY SECTION OF THE AGREEMENT, IF ANY; t3. ANY. YOU ACKNOWLEDGE AND AGREE THAT NO LING A `,"W R WARRANTY FOR S ARE IFITNES-S OF EN BY HOME DEPOT OR SERVICE PROVIDER, INCLUDING AN WARRAN Y PURPOSE, WARRANTY OF MERCHANTABILITY, OR ANY C"HER ORAL,FOR RESNY DEFEGTP IMPLIED WARRANTIES. HOME DEPOTS EXPRESS WARRANTIES AI�:EVOIDED R SCRIBED OR STANDARD CAUSED BY ABUSE, MISUSE, NEGLECT, ACTS OF GOD, LAC MAINTENANCE, OR IMPROPER CARE/CLEANUIPMEN tMtViiaf BE PAS �a+THROH BY HOME Y PROVIDED FOR GOODS, MATERIALS, OR Eta DEPOT TO YOU, AND YOU AGREE TO LOOK SOLELY TO SUCH MANUFACTURER A UFA DEPORT MAY ASSIST OF ANY H WACT IN SUCH GOODS, MATERIALS,RRANTY CLAIMS AGAINST MANUFACTURERS. EQU E U WITH WA THOUT PENALTY By 11, R1�HT OF—CAN E 1 14�;_YOU MAY CANCEL THIS AcR HT ON THEEEMENT THIRD BUS NESS OAY DELIVERING WRITTEN NOTICE TO HOME DEPOT BY MIDNIGHT AFTER SIGNING THE AGREEMENT. THE STATE SUPPLEN f-ENT CONTAINS A FORM TO USE IF ONE is SPECIFICALLY PRESCRIBED BY LAW IN YOUR STATE. Your payment(s) will be returned within ten (10) business days after Home Depot's receipt of Ycc r native- You must make available for pickup by Home Depot or Service Provider, at Your Home and in substantially the same conditiontact as when delivered, any materials, goods, or equipment delivered You. Alternatively, You may con Home Depot for instructions regarding return shipment at Home Depot's expense. 12. TERMjLg6TjQN This Agreement may be terminated by Hcr1e Depot for its convenience, and by either party for cause if the other party fails to correct a material breach within ten (10) days after receiving notice from the non-breaching party identifying _he breach. In the event Home Depot terminates this Agreement because You fail to provide Home l;epot or Service Provider Safe Access to perform the Services, or if either party terminates the Agreement because You decline a Change Order request resulting from unforeseen or hazardous conditic ns, then You shall pay Home Depot for Services provided through the date of termination plus any co,, s or expenses incurred by Home Depot or Service Provider as a result of the termination, 13. P_Ay_ E�.You will not pay anything to Service Provider, ,dthough Service Provider may present this Agreement to You for Your review and signature and/or collect Your payment(s) to Home Depot on Home Depot's behalf. 14. F F fi.NQ y.QI[`E OF �,AW. a.This Agreement shall be governed by and Interpreted in aex*rdance with#W laws of the State where prof_-' �'is physicafFy ed. t XY' The Home Depot Gqinersl T*rms ,"o Conditions b, JURY WAIVM YOU AND HOME DEPOT IRREVOCABLY AIVE ANY AND A11 RIGHT TO rRIA1., BY JURY IN ANY LEGAL PROCEEDING ARISING OUT OF Oi-, RELATING To THE SERVIGFS (W THIS AGREEMENT. I& sEV c.on&wans in the Agreement to be -ERABILITY;-The parties intend for the terms and or condition in complement", consistent, and enforceable under applicable 1 '.Ns. in the event any term be severed from the AgreemOr"t, bt4t 3 the Agreement violates 8PPlicabie law, such term or condition f I',, It sev only to the extent necessary to avoid such violation,without invOideting any other terms and condition of the Agreement, 16. ENTI-REAGREWENT- This Agreement Is the final, integrf,13d, and exclusive expression of the parties* agreement,which supersedes all prior and contemporsr,eous offers, orders, agreements, the Parties. understandings, representations, proposals, confirmations, ant iegotiations between ,overact, whether oral or written, No course of dealing, usage of trade, ct',0so of performance, course of co , vary any term or any other evidence of additional or different terms shall be 3 C.Missible to contradict or in the Agreement. is required under this Agreement, no 17, $E�C._URtT­ytRTE if You make all payment, security interest will be placed against Your property by Home -repot. If a security interest is Placed on Your property, it creates a lien, mortgage, or other claim againt'. Your property to secure Payment and may cause a loss of Your property if you fail to pay as requesvid. After paying on any completed phase of the Services and before making any further payments, You request from Home Depot Or I- Of, any right to place any claim against Se rvice Provider a signed, unconditional release from, or waive i Your property applicable to the work then completed. You may <isk an attorney about Your rights to discharge security interests. to de, uniquely altered. 18- RE—TURN$,-Custom order merchandise (i.e., goods that arcs cus m ma i ar colormatched, shaped, sized, or otherwise uniquely designed c- fitted to the requirements of a part cut space) is non-retumable, and its purchase price cannot be refurded unless incorrectly ordered by Home Depot or Service Provider, or unless damaged beyond repair in delivery or by Home Depot or Service Provider. Special order merchandise may be returned, and a rolund for all or part of the purchase price Provided, in the discretion of Home Depot. Please contact You-store for additional details conceming returns. 19. AGREE-We"Tacm a. to . You can visit www.hor-adepot.com > In-Store Special Orders at any time to access Your account for the following: • Update Your Agreement/Service Order Communication Preferances (email, text, Auto Call) • Contact The Home Depot for order assistance •View latest order status • Take action to schedule pickup for Your Service Order(s) b. TQ eesaWCo_rrjnurxiqns-: If You signed up to receivo updates about Your Agreement/ Service Order(s) via text message. You may receive multiple messages per order(including current and future orders) via automated technology to the mobile phone nimber You provided. The total number of messages received depends on the number of orders placed and order activity. Standard message and data rates apply. Not all carriers covered. You can text ST")P to 97710 to stop(You will be sent a confirmation message).Text HELP to 97710 or call 800-HOME-DEPOT for help. im The Home Depot General Terms ! Conditions unt to in-Store Special trc:o rs to access Update aucanats �#sitwww.homedepot,com Depots, and takes,tion 1 mncetin Preferences, ctntact The ome Your Agreement/Service Crderar a �rnent/Secn+#ce on ordeM if You signed up to receive uphlates about Your Ag hone C. Auto'call o�uln 41 �, receive multiple pre-recorded p Order'(s)via electronic voice communications (Auto Call), Yau aY to the phone number calls per order(including current and f callsure orders)via depends on����number la�arders y�uecaand el order sit You provided. The press total number o ate your Agreement/ activity. You can press 9 during a call to C►}at out or cast 8pQ-HOP,IE-DEPOT far help, www.homedepot,com } In Special Ordceontect rs to access Hom�r account to C►epot and take action on ordel M Service Order Communication Preferences, Yourregiment/ ce d. t1.OLCOt 1►1 �!� If You signed up to receive ai gr!(' aboutnc uding current and future orders) Order(s)ins Email, You may receive multiple Er1{Ftli$ per ? In- depends automated technology to the Email address You provided. L can°visit uwww.homedepnt.coma -ion depends on the number of orders placed and order acfivety Store Special Orders to access Your account to update on ardtrs ement/Service Order Communication Preferences, contact The Home Depot, and take action 20. N! If The Home Depot stare and Authorized SE3�vi artmender ar 1-F300-553-31 e unable a99 surer Your RUEOT� t Customer Care . ep questions, You may contact The Home Delay Custww Can:t ir"4W4'lttt .. !dotty } ♦ ���tF'Kf TAIYt�M t a,J JJrr R, � .•,R R • • r it ,• _ R .r f • t# 1 • _ ♦• :-♦ 1 a z - _ •• a • •:•i s iii ii • 1 t •• t • :/ • «_ _•. i - rs 1 • s s a:t • is * • -♦ :• •a # • !• : a t• • t • C w 1 : • - • - «• • •: • ::• r 1 trio«s : s # ! r:••.: #:"# # #� - • r- • • ii°i 1 1 • r • ":. i'i f #'i • r •: « • t • • f•. f •" t :t i 1 Y r 1 • l� k� •��,�-"+���� p'� � byx .� 'd�y '�"��*,��Ty"�L4��`yg�� _ lyvr. y�.. �`y`�' 2.dt I' xl• tf}/�an d Air+ kl� 4 4.x�T..� t.l-5�� T�i f t t' f�.Kn���++�h.`�*pd 2'✓}•". t � tr .. ------------ k ;`t R C3eneml inkrrnatidn is also available fnam the state Department t: Labor and Industries. I have rscsNsd a copy of this disclosure stBtWnmtrt. Dated this ay cif the year 20 Signature of Customer. 12 fr-,A- - ..= The contractor must retain a signed cop d re sn tent in his or her files W a minimum of three years and produce a signed or c copy ,If the disclosure statement to the department upon request. For mare information- Please refOr tc F(M 18,27.114. Snecjml E.Od CoJ tr ndudlno G. (1) The work to be performed Is a$fofkms: (2) The grade,quality,or brand name of materials to be usot is: (3) The dollar amount of the contract(or the portion of the ctin rsct)for roofing andlor siding is: (4.) The name and address of the roofing or siding safespem:,n Is: (5) The name,address, and contractor's registration number io the roofing or siding contractor: (6) The portions of the work Is to be subcontracted to anothor person or entity are: If the homeowner intends to obtain a loan in order to pay for all or part of the amount due under the contract,the homeowner shall initial this agreement belo vi: I intend to obtain a loan in order to pay for all or part of ttiii amount due under the contract. Initials: Y= KL Y• . t- bl V .���/1'.t i7_ 1.,, 11_ ).+ ► t.•iftf.' , 1 a s •ia. .a � i:x� r� • a 1 ` aid / • a/l�l• • s. s _ C I To ` ' clefs: , ) (Lead No.) Re: Home hnpr AWWWO ` itr `Entity? irrorn rt��t7 �' � Street Address or Location of Prc►PWW -- ~W .. ,. i PP THE REQUEST OF: s n� siry C.ere",cis, car equipment) (Name of (s)and ng •t� al THIS I$NOT A LIEN: This now is sent to You to tell You why+is Pie You of the services,materiels,air equipment for the lm t of You-property and to advise rights of these persons and Your reopo," ll"".Also take n„,tice that laborers On Your prolect Holy claim alien without sending You a POdce, OWNERtOCCUPIER OF EXISTING RESIDER IIAL PROPERTY Under Washington law.those who furnish labor,professlonel gervlcrs,mstortats.n who Are n e for the repair,remodel,or alteration of Your own*r occuplod p�rinclpei residenceThis claim aot Paid,have a right to enforce their claim for payment against Y rr ur properly as s construction lien The law limits the amount that a lien claimant can claim agofwr!Your property, Claims may only be made against that portion of the contract price You have nw yet paid to Your prime contractor as of the time this notice was given to You or three days after tide notice was malted to You. Review page 2 of this notice for more lnfarnratiOn and ways tc "Old lion claims. COMMERCIAL ANDIOR NEW RESIDENTU),L PROPERTY We have or will be providing profsssianal servicos, materials ot-equipment for the Improvement of Your commercial or new residential project. in the evsnt N"O:1 or Your 00ntractor fall to Pay us, we may file a lien against Your property.A lien may be c(airt»d for all professional ssrviCss, materials,or equipment furnished after a dabs that Is sbdy-diyt before this notice was given to You Or mailed to You, unless the improvement to Your proparty Is the construction of a new single family residence,then ten days before this notice was j i Oren to You or mailed to You. Sender(Contractor Entity)Name. r Sender Address: Sender Telephone Number: w. Brief description of professional servlcss,m als, or equlptsient provld Or tO be gravid IMPORTANT INFORMATION 0 N NEXT PAGE OR REVERSE SIDE IIMPORTANT INFORMATI::IN FOR YOUR PROT'ECTIOkl This notice is sent to Intorm You that we hsrw or Wltl proWd t Profefssiwwoi services,materials, or sriuipmem for""improvsmsrwt of Your Property,WO s'tp"ct to be poW by the Person who ordered our ssrviose,but If we are not paid•we have the riglt t to enforce our c1a rn by filing a construction Don against Your property. •LEARN more about the lien t"s and the meaning of this natkso by discussing them with Your for,suppliers,Deparo""t of Labor and Industrial,She firm sending You this notice. Your lender,or Your attorney. •COMMON METHODS TO AVOID CONSTRUCTION LIENS:There am several mothods available to proboct Your property fern construction dens,The folioevinq am two of the more commonlY used metltodo. 'DUAL PAYCHECKS(Joint Checks).When paying Ywr contractor for services or materials,You moy moko chocks payable)oIntly to tt m contractor and Owe Arms furnishing You this notice. 'LIEN RELEASES:You may require Your oontractm I Provide lien releases signed by ail the suppliers and subconb cWm frown whom You have received this notim If theY cannot obtain lien welesses becsu**You have roof rrdd them.You may use the dual Pay"check method to prateat Yourself. YOU SHOULD TAKE APPROPRIATE STEPS TO PROTECT YC f UR PROPERTY FROM LIENS. YOUR PRIME CONTRACTOR AND YOUR CONSTRUCTION LI:NDER ARE REQUIRED BY LAW TO QIVE YOU WRn-MN iNFORMATION ABOUT LIEN CL.A US.IF YOU HAVE NOT RECEIVED IT,ASK THEM FOR IT. as ard•tr rVp►op.ann Cumbmw Cara;t.aTt- 674=1 "W Home Depot-ales Paera F.nr Ruud,raw,1906.as.,Wana,.Dowryo s� s name Cumww Cora:t.sn sl - no EwprM.IMs+t-sw►aaaa 1Wry nwtf 1LW.We. ,►Mtetla,QWGftp 30M rve«cot•..tw topvi Vttlow•CAtMosrw tlapY P%*-c umot copy tUMNrnior� N1wMr•f1DlsetigroA �4. low NancE OF CAMCELLATIO?l Date of Transa tOn- Lo 7� r You may CANCEL this transaction.without any penalty or Qisli on, within THREE`3) BUSINESS DAYS hun the above ds%.The State Supplement imntains a form to use N one is specifically prescribed by law in Your If You cancel any pnnwty traded in,are payments made by�ou a the con "t Or saw, and any negotiable ire t executed by You will be returned w thin TEN (10) BUSINESS DAYS following receipt by the seller of Your Canceuatlon Notice, aorlc any security interest out of the transaction will be canceled. it You cancel, youmust twice available to the seller at Your re silence, in su daily &S 0`�r°d condition as when received,any goads delivered to You under'this contract or .or You may, N You wish, comply with the instructions of the seller re a€rding the return sh t of the goods at the seller's expense and risk. If You do make the goods available to the tastier and the seller noes not pick them up min 'TWENTY (20)CALENDAR DAYS of the date of Your Notice et i afncollation,You may retain Or dispose of the goods without any further obligation. If You fall to make the goods€tvaitable to the seller, or if You agree to return the goods to the Wier and fall to do so, them You r0main battle for pertcxmance of all obligations under the cotrtract. To(-.jrcei thiti transaction, mail, deliver,or email a signed a ie i lat copy of this anc011atjOn Notice, or any other writrecu nodca, of *041d a iM*uViat+', iu. (Email Adljrz;ssi Faf: 1 of se—;` e J? THE HOME REPOT (tart:nveype narne€f sorer or seiie€ ;s aut ort;r_U0 teP€e-le€tiaiivO) i-WAj 1_iwri AFNAnue Si,+V. Suite ttZ € EriFxt[ua � IVYA. r i,*ix"i7 3 (Address} (c sty) (Sit } (Zip) NOT LATERTHAN MiUNiUh' QF: b,,� "j� ^�Yh'3 �F/n'"r T c< Eas1F 3hfz d-,i.c' of ni YFYe�'.sl .'e s�i: I HERESY CANCEL TNtc TltANSAu~TI N. luat6 i (Buyer's Signature) {Buyer's panted name) x ft oft AS fit a ! « Is 441, Lin, -- _� ., S ? ; f fi c ROOFING PRICING WORKSNEET Pf=UCT raw+rO.a s41m"*WANOVAc.AM A"Ll"11?N TtrrtO't.tit)l t e ur. f443 e7 dC p dVancadroleooltOm Ulm HO �'"" S563 AdvartOed�*ple4�tWn System, Sequoia Canyon +,.. fT28 Oworrs�Coming Sulmame 25 trpw» f426 _-.-.- C sl TftCDuration %4" US�a ()wenrCOmf V Oai rxW,LT s�. f42T Low Slope Tao In -Liberty Intl,Ist layer rommat Fiat Roofing TPO-60 red a $700 State 4r>r® f34 tst layer Removal Surcharge Tar t Gravel GornposrttoruGravd saw+ f'S4 Aditor+el Layer Removal Too State suM. $90 (A)SUBTOTAL GDX d OSB Der*kV-NO s+a a $43 Plank Oaokir g-NO are. f4 InstallDeaing-NCI sanri ;t15 2"poly 150 (EPDM t TPO Only) sa... $133 Fiat Roo" en $156 Dens peck (B)SLISTOTAL Rowed Rrdga Vent Lin Ft. Included GAF 1 Master Flow Ventilation Turbine Vent �'� included Ow profile Vent EW induded Ede Included Rectangis SOM Vents Smut Vent Rorntd up to while T ftoe U1,rr fJ2 {C}MMTAL rq i} a Yr- y ° s R+ E L rw �..... ....-....._.-_ 'J ASh iAt -. OLt., . k$ 6r a "+ xtte<.f � Fri I i Al Sy.teln IF t.YC.I fi.F:OL3PIf�r F...: a d5AF4,4t,T SN#,NGLE= '. 1 (G RetAOVAL.—d — - — �f kyj{ f� f r i q Y i ,� �3F�C�j `a J'�f�fly �i �. �' �s',r'�Z.,a t«�t W'1 F. l��t'�•V 7s r i a. ,N Rooting V1Et1 nation A sessnwni t Uq{G1T?ti¢[ N ilT1P � .t�� lyr � { %• � � i� � ,.F ..S A*jc ,.; tt, a{tri, t,tW@,4ihO i{ l,L\IK'S*..6,Ff�Cf$fl�Y1t N�tt hind?l ,anti ttaa'k:raq+u+ ,%axt sGn"r i ri Nc�rtt:�t`t',�-arttg{tia,p*ar�ttir a�rr,tte,�,e�n�'e+Rllt'a`i te��c�°,' i�. r s;n�nc:w ,*,rc s�s„•r••,,;,r� "ir'tr, Elt5AU5t mrthc�c}c annot be tr,,% MINIMUM VEN'T ING RUQUI RE_MUN I S- SQUWe feet of Attie tiocx d*Ce IIR asu r n ets s 4n ui to c) 4h j EXHAUST FtAqld it:dge Vens(1- i 13 2b h 3.3 34 46 S,? =,y t3. 7t ! 7,4 Roi{et�f7t Vent L 9 17 26 34 43 l Si 60 fi$ 77 # 8 , 44 102 c,OW -7 10 10 14 i9 18 13 4) 4t, 51 I7 K 8 X1fi L 1 46 7 9 11 13 115 1T 1 2j Aftk VenUlsWn ReqbWe#penft t I otat Square Feet of AMC' � Category AtYioiirtt _ Type(c:hec:k one) Exhaust Cbj �f Re, o Riog'e 3 Rofted fridge Intake; (required) ,j ( 4 x 16- 0 is Intake, (existing) - -_ _ a x t If intake (needed)2 Z,,;) 4 Toeze ,ne sntakp ncpdeca. sutxr;�ct extstmg'4om rune U`J-sir is t t Q Ellil YI� AD :: � : :: y : :; _: . . ::�::