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(D N _ J N m O N O F N » (D O y' J N 93 N (D ^ Q J J � n � D 0 a O O l0 � 3 m N n N J (D n D O O_ V o � f0 ac� M m u, nan J a � N 0 N N rn n m m Jul 01 2013 12: 31PM 3604267154 P_.2 07/01/2019 08:10 FAX 300 427 7799 MASON CO IPERM17 CTR MASON COUNTY KW 1 DEP,�RTMENT OF COMMUNfrY DEVELOPMENT -+-. Mason bounty Dklp.rll,426 West l,edar Street PO sox', 1be,Shelton,WA 98584 t85I �/Id Y �ey�'+ www.whYason.w�ua (360)427-9670 eYd352 Balfalr(aen)27g.gy6T pma Mp)442_5289 F ' R oofing or y�� Type of Rco>)ng to be Applfed_ 3C)4e- (.Am,ro frr£ SSTro.t) C7t1SIlayers Roorplteh: i Z Tear off: Yu inQ. r Conatructlon• �o: �tiber� Roorrne il:iccepancy Hassflgcation) (--a,ned 6aa,q�pyy •) on M.Hw am lncluel®maxtafacture apie Cations verifmg materials moot roofing c S&C roo,,,,a c,ass.anaoes require art,plain draws to&. . Will iusnlaftu he iastillod?_y= y No Fxuting Insulation,describe Pt Existinft r0Cfg shall be i 1i"ted to the requirements of R-38 if electric heat,R-30 all others,IF: alhe roof's unbuwared crtmulsdoo is rmwvcd to the Iml of the shee1hins or b.Alllnsuluba in the roof/cet77ag was previo,asly jnafelled exrnior ro the shwa thing or noae>astent. Roofventihltionr describe •. :��C ,,,, d 1 Nameorsnalnes::. �L11� IatguJk 9ubjectPrapatyAddrevs: 2�{ ' (5© tU� S � U�� � E,l�a.,� 't„`� �j�S2�8 Asseasnrs parnpl mimber(s)• 2'3 ( d�eea ana pp,�mn+aerroqulrsd fret apPaeeGo�) Applicant- Marling address: & �Sta • . 4�3b� Phone c3-423^S�O2fs FAX ( %0 37�fi _ ��. E Mai1:�HLf�n �AIF'ic.c,P�aJ1Uk-, cu,� h 71t; ant: Date! 4 �l aurboru :son County represeotafive(s)to inspect 'property M ng this permk appIIGfien pmdsss for pwpores of verifying sire cop -Frid the hours of 2 am.and 5 Nee nnaot n r:..�,e.o.ua. o _ t N CONCRETE MECHANICAL MANUFACTURED HOME N Dale By w Footings l Setbacks Gas Piping Ribbons p Interior Date By Interior- Date By Date By W aFxneror Date By Exterior-Date B rat-up Z Point Load I Isolated Footings INSULATION Date By BIG/SLAB INSULATION Date By Data By FIRE DEPARTMENT Foundation Walls Floors Date Rv Date By Data By DECKS FRAMING Walls Date By Date By Data By PROPANETANKS PLUMBING vault Date By Date By OTHER Groundwork Attic Type. Uale By Date By Date By D.W.v DRYWALL Type 0 Data ey Inc Brace Wall ate By Date BY 3 D FINAL INSPECTION wy cj Water Line Fire Separation Date By Date By Date L'y O O Pass or Request Inspect. a Type of insp. Fail Date Date Done By Comments a i m m rn 0 1 rn Jun 28 2013 10: 07AM 3604267154 l P. 1 MASON COUNTY PERMIT — BUILDING PERMIT APPLICATION 426 W. Cedar • P.O. Box 186, Shelton, WA 98584 Shelton (360) 427-9670 • Belfair (360) 275-4467 9 Elma (360) 482-5269 On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner Kitsap Bank Company Name A-1 Roofing Inc. Mailing Address PO Sox 2 Mailing Address PO Box 5650 City Port Orchard State WA Zip Code 98366-0009 City Porl Orchard State WA Zip Code 98336-8650 Phone 360-328-4648 Jerry Winge Other Ph. Phone 360-373-8828 Other Ph. Lien/Title Holder Contractor Reg. # AlR001`111PR Exp. 05/2014 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 PARCEL INFORMATION - 12 Digit Parcel No. 12328-23-90001 Fire District Legal Description sw ntw,E of R/W Lot:A of SP#2487 Site Address (Please include street name, street number and city) 24180 NE State Route 3, Belfair Directions to site Shelton to NE State Route 3 in Belfair 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?Ye TYPE OF JOB - New Add Alt Repair x Other PRIMARY RESIDENCE ❑x SEASONAL ❑ Use of Building I Describe Work Composition Tear Off&Composition Re-Roof 49 Sq. 6/12 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 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. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. / X (^",iA,MCwr&- Date: 6/28/2013 ( Owner/Owners Re-presentative Contractor indicate which one i f lip FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department i,Public Works Department =ire Marshal FEES <9uildinq Permit Fee Site Inspection r !'Ian 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$ 1 TOTAL FEES