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III, 426 West Cedar Street - PO Box 186, Shelton,WA 98584 1854 www.co.mason.wa.us (360)427-9670 ext.352 Belfair(360)275-4467 Elma(360)482-5269 Roofing Sq ft area � Type of Roofing to be Applied ' f L�1.(_ Z r ��►. ; -'.� i Number of existing layers 1 Roof Pitch: EI 47 Tear off. VYes No f 1 Use of buildin ���Ti ��� — \%i Construction Type:'r-r l•— RoofinLF Classification (Occupancy classification) (wood,steel frame,masonry etc.) (A, or C) Include manufacture specifications verifing materials meet roofing classification. B&C roofing classifications require site plan drawn to scale. Will insulation be installed?_Yes VNo Existing Insulation,describe : A L i C_ Existing roofs shall be insulated to the requirements of R-30 i£ a.The roof is uninsulated or insulation is removed to the level of the sheathing or b.All insulation in the rooFceiling was previously installed exterior to the sheathing or nonexistent. Roof ventilation, describe : �� Name of Business: c� V. (��L- L SA Subject Property Address: �� L1 ( 'Z' Assessors parcel number(s) chJ VL (Address and parcel number required for all applications) Applicant- 11 '4E 'A AA A k2 Mailing address: `z t ck City `'F,4 l2State: tau A Zip:'�_ Phone (���) '�� `c'�`�I.i FAX 3 mod ) 75'� 40 6 E-Mai Vg e4 A- .L QC>C'y Applicant: Date: I hereby orize en"C epresentative(s) to inspect my property Monday-Friday between the hours of 8 a.m. and 5 p.m. during this permit amification process for purposes of verifying site conditions. ARC 11/30/05 H drive Comm.Re-roof doc FORM MUST BE COMPLETED IN INK j MASON COUNTY PERMIT L'WL PLEASE PRESS HARD BUILDING PERMIT APPLICATION 426 W. Cedar • PO. Box 186, Shelton, WA 98584 /2-f Shelton (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269 On the web www.co.mason.wa.us x �' ('�"►� APPLICANT INFORMATION CONTRACTOR INFORMATION Owner ' p� Company Name Mailing A(Mress Mailin Address c,) j City State Zip Code City _ - _ `fL State U�A Zip Code 5 � Phone Other Ph. Phone3CC I '�� Other Ph.275� Li 3 Lien/Title Holder Contractor Reg. E mail address E Mail Address 5­&4Tti3;4TYilcc1F 61` 4e I . eo✓`A Drivers Lic.# DOB Drivers Lic.#% D�{v�fc f DOB .�' &G 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 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 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/ 6"- TYPE OF JOB - ew Add Alt Repair Other ( ',f- PRIMARY RESIDENCE ❑ SEASONAL ❑ Use of Building ' Describe Work T"tj�,L!11 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 CONTIN ION OF WOR S BY MEANS OF A PROGRESS INSPECTION. Date: cf rA r�, �r.cFrr s Representative/Contractor indicate which one FOR OF CIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPR VED DENIED 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 Planning Review Fee Mechanical & Base fee Other Wood/Gas/ Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES