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Date By Date By FINAL INSPECTION Water Line Date94- S` By Date B Date B v By Y 0 0 0 0 CD cn o �d N � a O O n O O St W 3 0 FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NO.� 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 APPLICA[ T INFORMATION CONTRACTOR INFORMATION Owner CrU , �c_pt'-r � Company Name .�t)-F1-4r- tq7:_)2rCJF-I�Cz Mailing c� res �73 `70 Mailin Address City _ ` 1 State GcX Zip Code City State Zip Code CE Phone Z75 3&.2 Other Ph. Phone OtheAPh. Lien/Title Holder Contractor Reg. Exp. E mail address E Mail Address Drivers Lic.# DOB Drivers Lic.# kL 6 L 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. eD Fire District Legal Description Site Address Please,inclu e street namp, street um er 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 40 TYPE OF JOB - New Add Alt Repair Other LRIMARY RESIDEN E SEASONAL ❑ Use of Building ork NCj 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. ONNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocationpp Acknowledgement of such is by signature below.I declare that I am the owner,owners legal representative,or the contractorf><f E I V D declare that I am titled receive this permit and to do the work as proposed in the application.I declare that I have obtained the permis- sion from all th n essa parties.If permission is requi from any easement holder or any other party in interest regardirp tion or the wor posed the application, I have ob ned permission from them to apply for this permit and conduct the w o � - 8ELFAIR OFF X Date: . - L� E Owner/Owners Representative ontract (indicate which one) FOR OF USE USE BEY D T S OINT _ Accepted by. Planning Pd Ck# ! _Date Bld Pd eceipt Jw DEPARTMENTAL REVIEW APPROVED DENIED NOT,ESS, l Building Department / Planning Department Environmental Health Department 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 Mason County Bldg.111426 W.Cedar P.O.Box 186 Shelton,WA 98584 (360) 427-9670 Belfair (360) 275-4467 Elma (360) 482-526f Seattle (206) 464 -696 NON-STRUCTURAL RE-ROOF APPLI(I 'ATION It Z_ Roof Slope: Old Roofing Material: New Roofing Material: Sheathilig: 1�XlStillg IIISLIlatl()Il: New Inst,11.1ti011: RECEIVED Pool,Slope: Ulk- l.)b1v 15 It-1 & 15-1l? MAR 2 R'1(4 Slope Illost be indicated 'nod pilt 11, 4ELFAIR OFFICE "()of(*()%?(".I')'-': UB(_Section 1507 Seletl'•(' roof o7ox'06111"' Must be inqallod III arct,rdanrt t\Ith 11"11,1tioll: this('tI(leif: a. I'lle roof is unill"ll'Ited or Ill�o1,11i'm is IvIIW%-t-Id It,tilt.It.vei'll the sheathing')I, b 1\11 6111.11,11ioll ill Ill(, Ij,()f/(,,jjjlI I t,, Allii Veljtjja(ioll: UBC Sectioll :,():j•j Inclosed alticc all(l rafter'll-ClIS S111111 he SI-11111lic(l vvill) kl(,S!;-vcIltilatioll, I he net free ventI1,111011 ar •a shall not he jo� 111,1f, 1/150 of the area of the space to tic ventilated. If Rio%of the ventilating area is Provided from the 11 .1101-portion of tilt-'J"I,be ventilated, then 11300 is allowed. Applicant/Owner: `Dnv\� P�r"Y_ _011tractor: Parcel No.:A13 3 c)- ! C01 6 0 0 Pernik No.: Signature: Date: 5-7-Y., Reroofapplication.doc