HomeMy WebLinkAboutBLD2025-00043 Reroof - BLD Application - 2/11/2025 MASON COUNTY Permit No: -OC O4 3
DECEIVED
COMMUNITY DEVELOPMENT
Permit Assistance Center,Building,Planning FEB 11 2025
BUILDING PERMIT APPLICATION115 V1LAlder Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:Doug Rutherford NAME:TN Miller
MAILING ADDRESS:2315 N 59M Street MAILING ADDRESS:P.O.Box 206
CITY:Seattle, STATE:WA ZIP:98103 CITY:owla STATE:WA ZIP:98539
PHONE#1:206-949-4093 PHONE:360.2755702 CELL: 360-870-1010
PHONE#2: EMAIL:jayson@tnmillerramodelmg.com
ENWa:dmrutherford@comcast.net L&I REG#TNMILMR915KD EXP. 69/29/25
PRIMARY CONTACT: OWNER❑ CONTRACTOR E] OTHER❑
NAME sanw,.no-o EMAIL
MAILING ADDRESS CITY STATE ZIP
PHONE CELL ,. ENTAL
PARCEL INFORMATION: 1 ALTH
PARCEL NUMBER(12 Digit Number) 22220 33 00050 ZONING t fl
LEGAL DESCRIPTION(Abbreviated) Residential FIRE DISTRICT
SITE ADDRESS 12462 E STATE ROUTE 106 CITY Behir
DIRECTIONS TO SITE ADDRESS Mile marker 12 on state route 106
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO❑ SNOW LOAD:_psf J9
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW❑ ADDITION❑ ALTERATION❑ REPAIR❑� OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.)Residential
IS USE: PRIMARY❑ SEASONAL r❑ NUMBER OF BEDROOMS 1 NUMBER OF BATHROOMS 1
HEATED STRUCTURE? YES(Whole Bldg)❑] YES(Pan(s)ofBldg)❑ NO❑
DESCRIBE WORK Replace attached garage flat roof with a new engineered truss gable roof
SQUARE FOOTAGE:(proposed)
1 ST FLOOR 800 sq.ft. 2ND FLOOR 250 sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft. Attached❑ Detached❑ CARPORT 483 sq.ft. Attached E] Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC❑ SEWER❑ / NEW❑ EXISTING 0
PLUMBING IN STRUCTURE? YES❑ NO❑ Ifyes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NOO EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS
OWNER acknowledges that 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 and I further declare that I am entitled to receive this permit and to do the work as proposed.I have
obtained permission from all the necessary parties,including any easement holder or parties of interest regarding this project. The owner or legal
representative,represents that the information provided is accurate and grants employees of Mason County access to the above described property
and structure(s)for review and inspection. This permittapplication 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 ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATIO F 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
7 COUNTY CODE 14.08.42)
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DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH