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o CONCRETE MECHANICAL MANUFACTURED HOME
o Date By m
N Footings/Setbacks Gas Piping Ribbons
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Ao Exteror Date By Exterior-Date B c�t.� X
m Point Load/Isolated Footings INSULATIQN Date By <
Date By Data SLAB INSULATION By FIRE DEPARTMENT Z
Foundation Walls Floors Date By
Date By Data BY DECKS
FRAMING Walls Date By
Date By Data By PROPANE TANKS
PLUMBING Vault Date By
Date By OTHER
Gratndwork Attic
Type
Data By Data By Date By
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DRYWALL Type-
Int Brace Wall Date By to
Date BY Date By FINAL INSPECTION 0
Water Line Fire Seperalion G
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" rp MASON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
Mason County Bldg. 111,426 West Cedar Street
PO Box 186, Shelton,WA 98584
Nse www.co.mason.wa.us (360)427-9670 Belfair(360)275-4467 Elma(360)482-5269
NON-STRUCTURAL RE-ROOF APPLICATION
Roof Slope: 6 102
Old Roof Material: Corwtp
New Roofing Material: 1' t
Sheathing: r�1 Cdx
Underlayment: I//OlcQ�pew- 1 4e j R ,Ttsret ,
Existing Insulation: -�y
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: IRC section R905
Selected roof covering must be installed in accordance with manufacturer's specifications and I RC
requirements.
Insulation: WSEC 101.3.2.5 exception 2a & 2b
Existing roofs shall be insulated to the requirements of this Code 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 non-
existent.
Attic Ventilation: IRC section 806
Enclosed attic and rafter area shall be supplied with cross-ventilation.The net area shall not be less than 1/150
of the area of the space to be ventilated. If 50%and not more than 80%of the ventilating area is provided
from the upper portion of the space to be ventilated, then 1/300 is allowed.Applicant/Owner: 1�ey i r Contractor: S—'cly Parcel No: Permit No.:
Signature: ��<�. Date: ICJ!
ARP 10 N 04 re-olld ppdi buado
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MASON COUNTY PERMiT No f J)2 IZ-� 4
BUILDING PERMIT APPLICATION
426 W. Cedar• P.O. Box 186, Shelton,WA 98584
Shelton(360) 427-9670• Belfw (360)275-4467•Elma(360) 482-5269
On the web www.co.mason.wa.us
APPLICANT INFORMA�10 CONTRACTOR INFORMATION
Owner I W _0 Company Name— --
Mailing Address` o `7 _ Mailing Address
C' State LC Zi Code
City State Zip Code
Phone.2 lsc� - 73.z-7ut73 Other Ph. -fir' I 'a22a.��
Phone Other Ph.
Lien/Title Holder Sc1A& e Contractor Reg.# Exp.
E mail address "— E Mail Address
Drivers Lic.#w i RE LKMc),f PH 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
PARCEL INFORMATION- 12 Digit Parcel No Fire District
Legal Description
Site Address(Please include street name,street number and city) 0 al"LinuA,
Directions to site h,_,uevL L�
Will timber be cut and sold in parcel preparation?Yes ,o
Is property within 200' of Saftwater Lake j& 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?Y
TYPE OF JOB-New Add Alt Repair Other PRIMARY RESIDENCE ❑ SEASONAL
Use of Building U_1�.c� Describe Work �
No. of Bedrooms c2 No.of Bathrooms -.2,_Square Footage-1st Floor UO C)—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 ina=x-,de information may result in a stop work order or permit revocation.Admowledgement 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 enti led to receive this
perrrd 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 appricafion or the work proposed in the application,I have obtained
PaTnission from them to apply for this pemtit and conduct the work proposed The owner or agent on owners behalf,represerrts that the infomtabon
provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection.
PROOF OF CONTINUATION OF WORK G BY MEANS OF A PROGRESS INSPECTiOM
X Date
ers Representative/Contractor (mdcate which one)
F R FICIAL 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