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o CONCRETE MECHANICAL MANUFACTURED HOME y
Footings C Setbacks Date By Ribbons z
Gas Piping} D
O Interioa pate lay Interior-gate By bairn By
ti gate �. r—
y Exterior m Dote By Set--up m
Point Load t isolated FootingsINSULATION fC�N gate BY
BG!SLAB INSULATION Z
D By bite By FIRE DEPARTMENT Z
Foundation Walla Floors bate By
Date By Data By DECKS
FRAMING walis gate By
Bate By bate By _ PROPANETANKS
PLUMBING Vault Date By
Date By OTHER
Groundxvrk Attic
Data By date B
Type:
...........�.� ,_..,. bats By
Int.Brace Wall pate By 03
Date By Ovate By
FINAL_INSPECTIONEn
v Water Line Fire SoperaH C
Gate y Gate By Date 2D 86 C
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` Pass car Request Inspect. j o
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s Type of Insp. Fail_ Date Date Done By Comments
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MASON COUNTY PERMIT No. � �.�
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.we.us
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner Company N emsa, 4T"1���;"a )n c _
Mailing Address t? Q • -�/ 7
Mailing Address
City State "° r Zip Code _
City State Zip Code Y
Phone Other Ph. Phone Other Ph._
Lien/Title Holder Contractor Reg. # Exp. /
E mail address E Mail Address
Drivers Lic.# DOB Drivers Lic.A 1, 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 System
PARCEL INFORMATION - 12 Digit Parcel No. Fire District
Legal Description
Site Address (Please include street name, street number and city)
Directions to site
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
TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE ❑ SEASONAL ❑
Use of Building describe Work
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 E' 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 applicatio I declare that I have obtained the permission from all
the necessary parties. If permission is required from any easement holder or any other rty in interest regarding this application or the work
proposed in the application, I have obtained permission from them to apply for this perry ii and conduct the work proposed. The owner or
agent on owners behalf, represents that the information provided is accurate and grants amployees of Mason County access to the above
described property and structure for review and inspection. This permit/application beco imes 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 OFA PROGRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THEAPPLICATION.
X Date:
Owner/Owners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT Acce ted by: Date
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Planning Department
Environmental Health Department
Fire Marshal
FEES
Building Permit Fee Site Ins e tion
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 FE S
oo��r� MASON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
Mason County Bldg. III, 426 West Cedar Str�et
— -- PO Box 186, Shelton, WA 98584
I854 www.co.masonma.us (360)427-9670 Belfair(360)275-4467 Elma(360)482-5269
NON-STRUCTURAL RE-ROOF APPLICATION
Roof Slope: YA�
Old Roof Material: Co
New Roofing Material: r T
Sheathing: �-� C D x
Underlayment:A a/d
Existing Insulation: P. 30
New Insulation: NA
Roof Slope: IRC section R904.1
Roof slope must be indicated to ensure selected roof covering is owed on designed pitch.
Roof Covering: IRC section R905
Selected roof covering must be installed in accordance with manofacturer's specifications and IRC
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-ventila 'on.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: C 14 tLt h^ k� Contractor: ( � �a�., �,b I_t�o� G
Parcel No: a� S a 0 O d D :3 Permit o.:
Signature: Date: 61
ARC 10/19/04 re-roofapplication.do