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HomeMy WebLinkAboutBLD2005-00081 Cancelled ReRoof - BLD Permit / Conditions - 1/20/2005 Z -0 No 0 CD CL v m < Z O` fD — a) < CD (n 0 r C) m m o C -1 m C) a) m � � c m D v o : O C O C) CD D-Cf) C m n ) 3 1p CD � � mmmZ to = C) -n r � � z0 � 0 CD 0 O ' � � � �x m mWz z X � z � m =r = o z � D _ _ rn = o O o cn 7 TI Cn N cnCn 7 C7 O C7D zOC () D c Z CD 00 cNi, m --1 0 N mc) D --i > � � C m �, WMCD W Z x = O cn N -� cn cn c o o o W -n 0) m o n CD m m m o a . o o K m G) -, co �6 m moo $ -1 G) O m co' 3 3 cci r— O TI (D 0 m p W 0 a z m O tv cn a „ m m T 0 �° Ct) m Z � _ -, o OD D OC) O < v 6 r sv H Cn 0) o 0 o o o O � W m o o C-) a7 (n Z C Cl) - = Cn G) o m x 0 r' v O o CD v o o = 0 D w m — 0 m c u' , r t) rn 0 0 CD CD (n a -0 3 � o -1 t" 0) Z m g = 0 C 0 � cn -n m _ m r. y W cp „ r- --i Q ;o r- MM m ' o arm x 1 m 70 Cn � °° m Z CD CD _ C) —� co Z cn c) CD cn m W r 0 �) CD m C' o C 90 rn n 3 n cn = m O cn m N X 3 o Cn ? cn m m _ C7 v z ° cn —i °' co c O Z) CD3 ro ' _ = 00 tv � o9. 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CY.J � 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 INFOR TIO Owner `��+ Company Name cat �'���� � Mailin Address Z- Mailing Address City �C State G-;A Zip Code`l����' City ^C3�1��. c- State �� Zip Codes `SS LDS Phone 9`in-95 2 2' Other Ph. Phone f Other Ph. Lien/Title Holder Contractor Reg.# fn roc L44 a Exp. E mail address E Mail Address Drivers Lic.# DOB Drivers Lic.# 6-j0F&e_1(ZL4'9L'5 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 nistr' t Legal Description Site Address (Please include street name, street number and city) Z7-5�'4'O Directions to site a _v— Z -S v. t Will timber M cut and sold in arcel preparation?Y s/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 fQ0 TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE a SEASON L ❑ Use of Building Describe Work �c�-� �t ��✓ t.`<=�L- 1 c��� ��� �>�F' 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 th to ly for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information provided is accu a nd nts employees of Mason Co access to the above described property and structure for review and inspection. PROOF OF CO UATI OF WORK IS BY ME OF A PROGRSS INSPECTION. X ✓�� Date: I Owner/Owners Re resentati / ndicate which one FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED I 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 MASON COUNTY DEPARTMENT OF COMMUNITY MMUNITY DEVELOPMENT Pea"Pr11irWn8Pecti0nS/Addresslrt County Bldg_111426 W.Cedar g RO.Box 186 Shelton,WA 98584 (360j 4` z 04 Belfair(360) 275-4467 —,� -- Elma (360) 482-5, _Seattle (206) 464_6c NON-STRUCTURAL I� _�Oa�` _._..:_ E -A�'�LI� '.ATIO .N rz� R(x}f SIc}pc�: Old Rocli'in - Net-v Rocifing Material:`-�W� Unclerlayrnent: - -—_-- I-xisting I:nSLIlatioll: New ills,, Rotit-ShIpr•: Ulk l.thtt t= ►i-I <t ►i•1;� K,tnf stn tr•m rs 1 t.-tth•irt<tiC.lit'tttnr•taqur.r•t�•t9t•<tt',u,te,»<,rtn.• i�.rtlut�-r<t,<ne!<t�i};rtoctt.ili'h. 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