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o CONCRETE MECHANICAL MANUFACTURED HOME
o Date By Footings 1 Setbacks Ribbons ` fM
Gas Piping �
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Point Load 1 Isolated Footings Date By C
BG/SLAB INSULATION — ---------- G
Date By Data By FIRE DEPARTMENT r
Foundation Walls Floors Date By r
Date By Data By DECKS ic
FRAMING Walls Date By
Date By Data By PROPANE TANKS
PLUMBING vault Date By
Date By OTHER
Groundwork Attic
Date By Date By Type.
Date By
D.W.v DRYWALL Type
Int.Brace Wall Date By ICU
Date By Date By
FINAL INSPECTION p
Water Line Fire Separation N
Date By Date By Date By C
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MASON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
Mason County Bldg. III, 426 West Cedar Street
PO Box 186, Shelton, WA 98584
1854
_ �, www.co.masonma.us (360)427-9670 Belfair(360)275-4467 Elma(360)482-5269
NON-STRUCTURAL RE-ROOF APPLICATION
Roof Slope: / /_-
Old Roof Material: S(tea k--e
New Roofing Material: (,Ct,-A P
Sheathing:
Underlayment:
i
Existing Insulation:
New Insulation: r I0
Roof Slope: IRC section R904.1
Roof slope must be indicated to ensure selected roof covering is allowed on designed pitch.
Roof Covering: IRC section R905
Selected roof covering must be installed in accordance with manufacturer's specifications and IRC
requirements.
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 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 than 1/150
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: 1 t �V 1�l Y1(kB�� Contractor: ck,,5 e_ l� CGHf�L
Parcel No: o� �" L --0QJ4n Permit No.:
Signature: Date: 3 z
ARC 10/19/04 re-roofappliwion.do
FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NO.L .�PIO 1
PLEASE PRESS HARD 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 ]l1 T✓uu Pe,y- Company Name o% u
Mailin Ac1dress Mailing Address C)
City Y State �� Zip Cod . a CityPot -&c(tiavol State� Zip Code 3
Phone360--)-?--'!�-zC-Z Other Ph. Phone -74 o Other Ph.TKO-3y0-37YS-
Lien/Title Holder Contractor Reg. CIO; Exp.
E mail address E Mail Address
Drivers Lic.# DOB Drivers Lic.#roc.LLAf 1 a73DP DOB 7-/7- 73
SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic
Connect to Water System Name of Water System
Well Sewer System Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No. - - 77TTFn Fire District
Legal Description
Site Address(Please include street name, treet n d it ) ,L
Dir ctions t to
Will imber be cu and sold in parcef 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 Rp--jecr-- P PRIMARY RESIDENCE ff SEASONAL ❑
Use of Building 140L- Describe Work-reA-1-6'p l S"ak-c- W-e "P1! f"P
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.This permit/application becomes null &void if work or authorized construction is
not commenced within 180 days or if construction work is suspended for a period of 180 days.PROOF OF CONTINUATION OF WORK IS BY
MEANS OFFA PROGRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THEAPPILICATION.
I/,'ct /- --✓tli P-e rcc'S� Date: 71z 3 /U
Owner/Owners Representative/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
Fire Marshal
FEES
Building Permit Fee Site Inspection
Plan Review Fee EH Review Fee
Plumbinq & Base Fee Planning Review Fee
Mechanical & Base fee Other
Wood/Gas/ Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal
TOTAL FEES
Valuation $