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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 INFORMATIO Owner C - Company Name O R� 11v MailingAddress .Z r'_� MailingAddres - r City tate U14 Zip Code^ city EL StateWf4 Zip Code Phone.62�6--'NE8 G Other Ph. Phone a-=— - .-— Olher.Ph. Lien/Title Holder Contractor Reg. xp E mail address E Mail Address Drivers Lic.# DOB Drivers Lic. DOB SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic =xisting Septic Connect to Water System Name of Water System Well Water System Name of Water System PARCEL INFORMATION- 12 Digit Parcel No - - Fire District Legal Description Site Address (Please include str et name st et number nd city) / Directi ns t i e /- n b Will timber be cuf 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?Y TYPE OF JOB- eAdd Alt Repair Other P MAY BI L Use of Building CP 0/AJ Describe Work 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.Admowledgement of such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that I ntitled WAIto 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 is required from any easement holder or any other party in interest regarding this application or the work proposed in the application, permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,rep t theTi provided is accurate and grants employees of Mason County access to the above described property and structure for r,=- ie 7 PROOF OF t�ONTI T1ON OF WORK IS BY MEANS OF A PROGRESS INSPECTION.fi�/ ' O�� S X Date_ QS R Owner/Owners R resen ive ntractor indicate which one FFI�E FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPR VED DENIED NOTES Building Department Planning Department Environmental Health Departmen Public Works Department Fire Marshal L,C C FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing&Base Fee Planning Review Fee Mechanical&Base fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation$ TOTAL FEES MASON COUNTY PERMIT NO. ✓v 7 BUILD eNG-Po RMI 6APPo IWA 850N _ (), Shelton (360) 427-9670 - Belfair (360) 275-4467 - Elma (360) 482-5269 On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATIO Owner C - Company Name R+~ 1 Mailinc�Address% �VL5y r% Mailin Address1 ,71 City StateL�Zip Code a City State Zip Code Phone Other Ph. Phone he h. Lien/Title Holder Contractor Reg. xp. E mail address E Mail Address 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 mow. PARCEL INFORMATION- 12 Digit Parcel No " Fire District Legal Description Ll Site Address (Please include street name, st et number and city) / Directions to i n Will timber be cu 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?Ye TYPE OF JOB New Add Alt Repair Other P MAY Iagr AS L Use of Building A / Describe Work 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 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 necessar"' fission is required from any easement holder or any other party in interest regarding this application or the work proposed in the applicat , permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,repre hat the i. n provided is accurate and grants employees of Mason County access to the above described property and structure for revi�i19 -ion. PROOF OF CONTINUIkTION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. 4 200.5 X Date•, • •Q. _ �ELF4/R O Owner/Owners ROWresentafive/ ontractor indicate which one FF��E FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date ' DEPARTMENTAL REVIEW APPR VED DENIED NOTES Building Department Planning Department Environmental Health Departmen Public Works Department Fire Marshal c C FEES Building Permit Fee Site Inspection i Plan Review Fee EH Review Fee f Plumbing & Base Fee Planning Review Fee Mechanical & Base fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT ' Perm t ProcesskWrmpecUonatAddremIng . Mason County Bldg.III 4W W.Cedar P.O.Box 18Q Stwtton,WA 98WW (360)427-9670 Belfair(360)275-4467 Elma(360)482-5269 Seattle (206)464-6968. NON STRU RE-ROOF APPLICATION Roof Slope: (9 Old Roof Material: ec"A-c p , New Roofing Material: Sheathing: Underlayment: �. Existing Insulation: New Insulation: �- Roof Slope:IRC section R904.1 Roof slope must be indicated to endure selected roof covering is allowed on designed pitch. Roof Covering:I(RC section R905 q G Selected roof covering-am t be installed in accordance with manufacturer's specifications and5j . �. Insulation WSEC VL3.2.5 exception 2a&2b 04p,,t Existing roofs shall be insulated to the requirements of this Code if: a.The roof is uninsulated or insulation is removed to the Level of the sheathing or, b.All insulation in the roof/ceffing was previously installed exterior to the sheathing or non-existent. Attic Ventilation:IRC section 806 Enclosed attic and rafter area shall be supplied with cross-ventilation.The net area shall not be less dm IJ150 of the area of the space to be ventilated.If 50%and not more than 80%of the ventilating area is provided from the upper portion of the space to be ventilated,then 1/300 is allowed Applicant/Owner: AA J C ha JE:rKL n A� Contractor: -51 cap-� Parcel No: �Q.330 -SO —D 0005 Permit No.: Signachm: Date: ` ARC 10/19/04 re-mof Vp1kz ionAm. I