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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 sci[,L 0a "CirnI Company Name_AA� P fCn Mailing Address 2,t1 • 2�CX 19 - Mailin Address t c,y, S S City n State L,)R Zip CodeM Sq�i City State \-' A, Zip Code' Phone kh- _1 S- _SS5 Other Ph. Phone lb 6 -4,--)l-$611 Other Ph. Lien/Title Holder Contractor Reg.#Rrrx:Di-V 16909 Exp. 5-I-b a E mail address E Mail Address-%prmi Ar►nc.Q M-50 .LdA 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. - — Fire District Legal DescriptionTrcir vv m9 Site Address (Please include street name, street number and city) Di 5R-�rections to siteL VK 61,41, T Arl, lo-iT WnAn Will timber be cut and sold in parcel preparation?Yes CNo 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 o TYPE OF JOB - New Add Alt Repair Other PRI RRESIpENCE SEASONAL ❑ Use of Building Describe Wor S ` r No.of Bedrooms No.of Bathrooms Square ootage- 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 accurate and grants employees of Mason County access to the above described property and structure for review and inspection. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. X L_ �a Vn efll n o n_, Date: Owner/Owners Representative ontractor indicate which one FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department 'G� Planning Department ( t Environmental Health Department Public Works Department Fire Marshal FEES Building Permit Fee Site inspection Plan Review Fee EH Review Fee Plumbing & Base Fee PlanningReview 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. 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 t" •... Company Name Mailing Address i y Mailing Address —State Code < ` City -+ State ZipCode City p Phone h Other Ph. Phone Other Ph. Lien/Title Holder Contractor Reg.# Exp. 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 PARCEL INFORMATION - 12 Digit Parcel No. + i r r:, Fire District Legal Description Site Address (Please include street name street number and city) Directions to site 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 Other PRIMARY RESIDENCE E] SEASONAL ❑ Use of Building Describe Work ` r 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 accurate and grants employees of Mason County access to the above described property and structure for review and inspection. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. X Date, Owner/Owners Representative/Contractor indicate which one FOR OFFICIAL USE BEYONDTHIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department # 14 .S 'e r fS .• - Environmental Health Departmen Public Works Department Fire Marshal 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 DEPARTMENT OF COMMUNITY DEVELOPMENT Permit Processing/Inspections/Addressing c,,X a7- 7 ? Mason County Bldg.III 426 W.Cedar P.O.Box 186 Shelton,WA 98584 (360) 427-9670 Belfair (360) 275-4467 Elma (360) 482-5269 Seattle (206) ;6 13 NON-STRUCTURAL RE-ROOF APPLICATION b Roof Slope: Old Roofing Material: New Roofing Material: _ Cb-w Sheathing: Underlayment: $ Tt 15 -�e Existing Insulation: New Insulation: imp Po5 i� o v, T- a r df - R-e reo f R.00'Slope: UBC Table 15-6-1 & 15-B 2 Roof slope must be indicated to ensure selected roof covering is a;lo�ved on designed pitch. •y Roof Covering: UBC Section 1507 Selected roof covering must be installed in accordance with m,anufacturer's specificatio.is and 'JEJC requirem.>n;s. Insulation: WSEC 101.3.2.5 exception 2a &2b 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/ceiling %vas previously installed exter or to the sheathing ar r, ,n• x,stcnt Attic Ventilation: UBC Section 1505.3 Enclosed attics and rafter areas shall be supplied with cross-ventilation. The net free ventilation z.r ,i si,all not �)(2 less tF:: 1/150 of the area of the space to be ventilated. if 50%of the ventilating area is provided from tf-.e i:)acr pettier. of the Lc be ventilated, then 1/300 is allowed. Applicant/Owner :�UQhy12 M. Vk Contractor: • �— , Parcel No.: 22 �JO _ 5 -- �� O Permit No.: Signature: ` t'n Q c5111in Date: — Ye-roof application.doc �nFUtyy n ca;�C-)