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A VJU ttR T)ii•jr,4f � ( Company Name Mailing Address pn Rfi)L 5&3 Mailing Address City -a 1 0. State WQ Zip Code 9752 Sy City State Zip Code Phoner?' 1 '� S- oc14 Other Ph. Phone Other Ph. Lien/Title Holder Contractor Reg. # Exp. 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 Sewer System Name of Sewer System PARCEL INFORMATION - 12 Di it Parcel No. - — ► Fire District Legal Description SA m ;3.-fh0r S Home 't (i td -T?,S W. 31)' 0 f -M W7 Site Address (Please include street name, street number and city) 2 2-461 Sf• Rt. 3, I K611 r i WA Directions to site Will timber be cut and sold in parcel preparation?Ye l No Is property within 200' of Saltwater Lake - River/ Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs 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 P/�I1 ARY RESIDENC �i9 SEASONAL ❑ Use of Building Describe Work ,'u r1 ` '� �� t t(!! No. of Bedrooms No. of Bathrooms_ Square Footage- 1st 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—Widto Serial No. No. of Bedrooms Bathrooms Type of Heat Purchase Price$ Replacement U�Yes 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. This permit/application 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 IS BY MEANS OFAPROGRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. X )r�g Date 2 (o- o-7 Owner/Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: `. Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department C ? Planning Department Environmental Health Department Fire Marshal FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing & Base Fee Planninq Review Fee Mechanical & Base fee Other Wood /Gas / Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation TOTAL FEES L- 3 Z Building �jL; C, Permit# JA MASON COUNTY BUILDING 111 426 W. CEDAR SHELTON, WASHINGTON 98584 (360) 427-9670 CORRECTION NOTICE Job Location This structure has been inspected by Mason Count Building Department and the followingV y g p rtment VIOLATION of County Laws and Ordinances has been found: Items Listed below must be corrected to gain code compliance q � �� _T \ , OLD 2 n O-7 - Go Z qJ 11 07_ You are hereby notified that the above corrections shall be made BEFORE PROCEEDING WITH ANY FURTHER WORK - C ll for re-inspection when corrections are made before co ntinuing ❑ Make corrections, items will be checked on next inspection ❑ OK to ❑ This is not a complete inspection . Department 1.. Date t � '7 - - Inspector — i _ Parcel Information for parcel number: 123325000111 Page 1 of 1 MASON COUNTY A&011 washing ton Government i CountyMason r a. Ws&Addresses Codes& Regulations Community Links Visit Mason County Search our Site Departments Assessor Parcel number: 123325000111 smalm Treasurer Owner Information Records BELFAIR WATER DISTRICT PO BOX 563 ►New Search I BELFAIR WA 98528-0563 ►Parcel Detail Taxpayer Information ►Parcel Value BELFAIR WATER DISTRICT PO BOX 563 ►Site Built Buildings BELFAIR WA 98528-0563 WH and Personal Legal Description Property ISAM B. THELER'S HOME & GAR TRS N 30'OF TR 47 ►Sales Info Site Address ►Taxes Reval Area 12 Field Sheet IFS 05309:47 Wernl is Land Size* 0.66 Land Use WATER ►Profile (Summary _ UTILITIES/IF View of all items) Tax Code 276 Tax Code Description 1 403 A P3 F W1 Census Tract Click Here * if the value is .00(zero) then the property is most likely in a plat and acr( usually carried on platted lots Last updated: 1 1/16" 007 Information may be inaccurate and outdated. Please refer to the Assessor/Treasurer Offices to verify any infonnation Assessor Home Treasurer Home Search our Site Disclaimer Director', Z � I tttl� .3 T P��l http://www.co.mason.wa.us/astr/parcel_detail.php?parcel number=123 325000111 11/26/2007