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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 INFORMfION SGZ•The �' rie -jir�� Owner �5 i ��r1 �Y Company Name -+ -t Mailin Addres pc;a 3 Mailin Address hC B City tn el State 4L^_Zip Code City ' r State 4-14 Zip Coclw2�sS.� Phone 3��`3`f�S 5 3 Other Ph. Phone 1-6-0 '2_75"Z`-1/ -- Other Ph. Lien/Title Holder Contractor Reg.# r-C"L420 Exp. _11 17 0!J E mail address E Mail Address Drivers Lic.# DOB Drivers Lic.#�Ft c�C�,�L�l�+S r--3 DOB , Z 3 SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System Welt Water System Name of Water System PARCEL INFORMATION - 12 Digit Parcel No 1C14 - 30 L/ Fire District Legal Description ' Site Address (Please inclu e street n e, stree number and city� '12!?)i 1 14L-%S•A iO r4L Directions to site -0 L31,0 3 U ic+c /'Q tt' - S S 4K, AI h rrt 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 /1 G` TYPE OF JOB - New Add Alt Repair Other_�—� I ARY RE IDENCE SEASONAL Use of Building z � Describe Work ti-' Sf��+-�=' -A � 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 entitled to receive this permit and to do the work as proposed in the application.I declare that I have obtained the permis- sion from al e neces ry parties.If permission is required from any easement holder or any other party in interest regarding this applica- tion or the or ropo din the application, I have obtained permission from them to apply for this permit and conduct the work proposed. X Date: Owner/Owners Representativ /Contr for (indicate which one) 1 FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Planning Pd Ck# Date Bld Pd Receipt No. DEPARTMENTAL REVIEW APPRO ED DENIED NOTES Building Department RECEIVED Planning Department Environmental Health Department ' Public Works Department SRFAIft OFFICE Fire Marshal FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing & Base Fee PlanningReview 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.111 426 W.Cedar P.O.Box 186 Shelton,WA 98584 (360) 427-9670 Belfair (360) 275-4467 Elma (360) 482-5269 Seattle (206) 464-6968 NON-STRUCTURAL RE-ROOF APPLICATION Roof Slope: Old Roofing Material:New Roofing Material: Sheathing: --- c Underlayrnent: l� I b F&--A V _-- Existing Insulation: yct.7 _ - New Insulation: kD Roof Slope: UBC"Fable 15-13-1 &15-13 2 ROof slept'must be indicated to ensure selected roof cuvel IIlg is allowed on desi,t;fled pitch. Roof Covering: UBC Section 1507 St'lt'ctt'd roof awering must be installed in accordance k%itb manufacturer's specifications and UBC reduirrnient,�. Instllallon: W5I:C 101.32.5 c,sception 2a &21) F.xistinr; roofs shall be insulated to the requirements of this Code if: a.The roof is uninsulated or insulation is rcanoved to the level of the Shea thIIIg or, b. /III insulation in tilt'r()of/cciIin�; way piIwiuu'lv installed r\lerim to the s,)wothin,;or non-e\itlrnl. Attic Ventilation: UBC Section 1505.3 Enclosed attics and rafter areas shall be supplied with cross-ventilation. 'I he net free ventilation area shall not be less than 1/150 of the area of the space to be ventilated. If 50`%,of the vcntilaling area is provided f-om tilt'upper portion of the spare to be ventilated, then 1/300 is allowed. Applicant/Owner : M�5 c M� y\ Contractor: Parcel No.: � e5C) 0L 0<6 Permit No.: 030 v Signature: r� Date: C— Re-roof application.doc