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Exp. 5-1-nsl 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 Sewer System Name of Sewer System PARCEL INFORIK ION - 12 Digit Parcel No. — — Fire District Legal Description a Site Address(Please i clude street name, street number and city) — 1'� Directions to site (kit t4orANnS'kn(-p- 9A- Will timber be cut and sold in parcel preparation?Yes Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes o TYPE OF JOB - New—Add—Alt—Repairer Other PRIM X ESID CE SEA$pyAL ❑ Use of Building Describe Work Yy No. of Bedrooms, No. of Bathrooms Square ootage- 1st Floor 2nd Floor 3rd Floor Basement Deck Covered Deck Other Sq. ft. Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make Model Year Length Width Serial No. No. of Bedrooms No. of Bathrooms Type of Heat Purchase Price$ 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 O APROGRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVAUDATE THE APPLICATION. X Date: —)(o Owner/Owners Repres tative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES i Building Department Planning Department Environmental Health Department Fire Marshal FEES Buildinq 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 SON COUNTY- DEPARTMENT OF COMMUNnYXIEVELOPMENT Permit ProcessingAnspecdons/Addressing Mason County Bldg-111426 W.Cedar P.O.Box 186 Shelton,WA M84 1360)427-9670 BWair(360)275-4467 Eima(360) 482-5269 Seattle (206)464-6968. NON STRU RE-ROOF APP LICATION Roof Slope: Old Roof Material• New Roofing Material: Sheathing: - Underlayment: � e Existing Insulation: a New Insulation: Roof Slope:IRC section R904.1 Roof slope must be indicated to ensure selected roof covering is allowed on designed pitch. Roof Covering:1RC section R905 Selected roof covering-must be installed in accordance with manufacturer's s pecifications and IRC requirements. Insulation:WMC IOL3.15 exception 2a&2b Existing roofs shall be insulated to the requirements of this Code if. a.The roof is unksulated or insulation is.removed to the level of the sheathing or, b.All insulation in the roof/eetling was previouslymstalled eaterior to the sheathing or non.esisteat. Attic Ventilation:IRC section 8% ry Enclosed attic and rafter area shall be supplied with cross-vemt7ation:1he net area shall not be less than 1/M of the area of the space to be Ventilate&If 50%and not more than.8o%of the ventilating area is provided from the upper portion of the space to be ventilated,then 1/300 is allov & Applicant/Owner:Trp M • a\" �'�� Contractor: - �- p(Y�Yl �'�lC, r Parcel No: rr�;L 331 SO OMO Permit No.: Signature: -Date: ARC 10/19/04 mroof applicadon,doc.