HomeMy WebLinkAboutCOM2012-00136 Cancelled ReRoof - COM Application - 3/25/2013 MASON COUNTY PERMIT NO 026M 26121-Wt-3�'
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 INFORMATION
Owner Larry Lawrence Company Name The Roof Doctor- Inc.
Mailing Address 1180 E. Pickering Rd Mailing Address PO Box 851
City Shelton State WA Zip Code 98584 City Shelton State WA Zip Code 98584-0851
Phone 360-426-9505 Other Ph. Phone 360-427-8611 Other Ph.
Lien/Title Holder Contractor Reg. # RQQFDI*168NR Expo'
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 Water System Name of Water System Ift
PARCEL INFORMATION- 12 Digit Parcel No 22132-11-00190 Fire District
Legal Description
Site Address (Please include street name, street number and city) 1180 E. PickgrirMfAd Aelton
Directions to site Take E SR-3 Turn right on Pickering Rd. look for S ence ak Grill on the right.
Will timber be cut and sold in parcel preparation? Yes No
Is property within 200' of Saltwater Lake -River/'Leek Pond
Wetland Seasonal Runoff Stream Slope r uff � 15%
Is this permit submittal the result of a Stop Work Notice,Correction RMMor other enforcement action?Ye o
TYPE OF JOB - New Add_Alt Repair X Other PRIMARY RESIDENCE ❑X SEASONAL ❑
Use of Building DCached
ibe Work Torch D
No. of Bedrooms No. of Bat Square Fo ge- st Floor 2nd Floor
3rd Floor Basement ck Cover D Other7ft Sq. ft.
Garage Attached A e Detached
MANUFACTURED HOME INFO ION - Make Mo Year_
Length Width Se No. of Bedroo No. of Bathrooms
Type of Heat a Pric Replaceme s/No
Inst Certi ti
ER/BUILD know) es ission of inaccu information y result in a slop w rd permit revocation.Acknowledgement of
(equired
by signN
tur low I d tha am the owner,own legal repr ntative,or the ra rther declare that I am entitled to receive this
and to d in the application. I decla a obtained the m all the necessary parties.If permission is
fromr any other parry in interest reg g this application o p ed in the application, I have obtained
sion fr permit and conduct the work proposed. The owner or ag owners behalf,represents that the information
ed isoyees of Mason County access to the above described prop rty and structure for review and inspection.
F OFORK IS BY MEANS OF A PROGRESS INSPECTION.
1 Mc i"rw Date, 11/2/2012
Owner/Mrs- eipresentative Contract indicate which one
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
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