HomeMy WebLinkAboutCOM2010-00095 ROOF REPAIR - COM Permit / Conditions - 10/29/2010 Cl) v
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N CONCRETE MECHANICAL MANUFACTURED HOME N
0
o Footings I Setbacks Date Gas PipingBy Ribbons Z
00 Interior Date By interior-Date By Gate By 0
Exterw Date By Exterior•Gate Bv 0
cri Set-up
INSULATION C
Paint Load!Isolated FootingsClete By Z
B4 I SLAB INSULATION — �
Gate By tote By FIRE DEPARTMENT T <
Foundation Waits >
Flaara gate BY D
Gate By Data "y DECKS _v r
FRAMING Watts Cate By
Date Z f j c By 4- gate By PROPANE TANKS Fn
PLUM ING Vault fate By
Date By OTHER
Groundwork Attic
Gate By Type
Date By •. •., ., bate By
a_w.v DRYWALL. Type 0
Int.Brace Wall Date By 0
Hate By gate By ic
FINAL INSPECTION N
Water Line Fire Seperatian o
Bate By Hate By Cate By o
Pass or Request Inspect. c
Type of Insp. Fail Date Date Done By Comments CA
0
MASON COUNTY PERMIT NO.0,0M Zblb • OC,����
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 INFORIVIATION CONTRACT IR INFORMATION
Owner czon Company NMailin Address Mailing Addr
City State(LALA—Zip Code 2586,120 City State Zip Code
Phone M I 'Dqgto Other Ph. Phone I 4either Ph.
Lien/TWB-HQkkr Contractor Reg. Exp.
E Mail Address
# B@g- 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 INFORMATIO - 12 .git Parc I No AQ Fire istri
ILegal Description L. s
Site Address(Please inc de ?reekname, street number and city) 11 .5.
Directions to site 1 t
Will timber be cut and sold in parcel prej ration? Yes o n �,/
Is property��w,)1thin 200'of Saltwater Lake River/Creek %4 Pond /mod
Wetland _Seasonal Runoff n Stream A Slopes or Bluffs > 15% 1A
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 Y RESIDEN ❑ S SONAL ❑
Use of Building _ Describe ork ® W�-0 P PX 1's',l(Y?_.O
No. of Bedrooms No. of Raarooms Square Footage- 1 st Floor 2nd Floor
3rd Floor Basement Deck Covered Deck Other Sq.ft.
Garage Attached Detached Carport Attached Detached
ANUFA RED HOME ORMATIO I Ma Model Year
L ngth idth Seri No. o. of rooms N . of Bathr s
Ty e of eat Pur hase Pr' e$ Repl ce ent Uni . Yes/ o
Ins r Name Certi icati
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 f this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information
provided is accurate and grant e ployees of Mason County access to the above described property and structure for review and inspection.
PRO OF CONTIN ATI F O IS BY ANS FA PROGRESS INSPECTION.
X ate:
Owner/Owner, epre entative/Contractor (in irate which one)
FOR OFFICIAL 6SEBEYOND THIS POI Accepted by: Dater
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Planning Department r °fin n iUj
Environmental Health_Departmentne,
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 FEE