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HomeMy WebLinkAboutCOM2007-00031 Final ReRoof - COM Permit / Conditions - 4/12/2007 FORM MUST BE COMPLETED 1N 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 m APPLICANT INFORM TION CONTRACTOR INFQRMATION Owner Company Name ,�® r/ Mailin dress` ev �`� Mailing Address City 14- State�Zip Code City > Stated Zip Code Phone 177 ,,05f 7 7 Other Ph. Ph r Ph. 1-1'13.4-333 Lien/Title Holder Contractor Rea. Exp. 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 Syste PARCEL INFORMATION - 12 Digit Parcel No. °7 Fire District Legal Description .Q.'.fj2 czea i Site Address (Please include street name, street number and city) Q i Directions to site Will timber be cut and sold in parcel preparation?Ye o Is property within 200' of Saltwater —&Lake ,.o River/Creek Pond r Wetland r- Seasonal Runoff 4 Stream Slopes or Bluff 5% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Ye No TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE ❑ SEASONAL ❑ Use of Building `'�' 6 describe Work 649 k3 9,('­ No. of Bedrooms No. of Bathrooms _Square Footage- 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 OFAP O I ECTIO ACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THEAPPLICATION. X �—-�. Date: L �ene7�s---Representative Co c o (indicate which one) FOR O ICIAL USE BEYOND T POINT Accepted by: Date DEPARTMENTAL REVIEW APPRQYED DENIED NOTES Building Department Planning Department Environmental Health Department Fire Marshal L ! 1 1 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 d Ear Pre-Paid at Submittal Valuation $ TOTAL FEES bBoK Co MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT Mason County Bldg. III, 426 West Cedar Street -- PO Box 186; Shelton, WA 98584 I854 www.co.mason.wa.us (360)427-9670 ext.352 Belfair(360)275-4467 Elma(360)482-5269 Roofing Sq ft area 45 C Type of Roofing to be Applied Number of existing layers Roof Pitch: L11Tear off: _Yes 4No V� Use of building i� bl` Construction Type: ®Q Roofing Classification A (Occupancy classification) (wood,steel frame,masonry etc.) (A,B or C) Include manufacture specifications verifing materials meet roofing classification. B&C roofing classifications require site plan drawn to scale. Nc � 1,AY Will insulation be installed?_Yes )(No Existing Insulation, describe �h r5 Existing roofs shall be insulated to the requirements of R-30 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 nonexistent. Roof ventilation, describe is as C'-. C-) Name of Business: �C� A WfLE_1_X.A'1 Subject Property Address: s f Assessors parcel number(s) 1 V-o'Sa`1`�9 0 ( -7 5— (Address and parcel number required for all applications) Applicant- Mailing address: City: State: Zip: Phone ( ) FAX ( ) E-Mail: NMI _F Applicant: Date: I hereby authorize Mason County representative(s) to inspect my property Monday-Friday between the hours of 8 a.m. and 5 p.m. during this permit application process for purposes of verifying site conditions. 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