HomeMy WebLinkAboutDIS2017-00009 - FIR Inspections - 12/11/2023 r
Case Number.-D _
Mason County Investigation Report Form
Parcel Number. 20 Z �?— -
Violation Site Address: ���Q— (�S �TWy �y�
PropertyOwner(s): Rol:!slg—� n _.....................--- Phone#: _._............ _- ....---....-----.--._.........__._......_--............._................._._.
MailingAddress:............_..........._._......._.._......-----.--...__..................................._._._......_.............. ............................_..__..------..................----........._......_......_........._......__....__.._..
Tenant/Contractor/Operator on site: ....................._.__
Directions to Site:
Description of Concern:
Under the provisions of the Public Disclosure Law, RCW 42.56.240, the complainant may indicate a desire
for disclosure or non-disclosure of their identity. If non-disclosure is chosen, this portion of this form will
not be released to the public unless this case is filed in court. Iffiled,your name will be disclosed ifyou are
a witness in the case.
Mason County investigates possible violations on a complaint basis only. Therefore,the name of the person filing
the complaint should be provided.
Please check one of the following:
Q Please do-aot.disclose my identity-1 understand that disclosure may be required by court order or if this
matter goes to court.
❑ You may disclose my identity.
Name(please print): Phone:( )
Address:
Street City State Zip
Signature of Complainant: Date:
THIS SECTION FOR MASON COUNTY USE ONLY
Complaint Received by: Date:
Complaint Received by: ❑ Phone ❑ Email ❑ Web Site ❑ In Person
Department of Concern: ❑ Building ❑ Planning_ ❑ Fire ❑ Public Works
Environmental Health: ❑ Solid ❑ On-site ❑ Wells ❑ Food ❑ Other
Investigation Date and Findings:
0j
Date Closed: Reason Closed: Initials:
i )
CONCRETE MECHANICAL MANUFACTURED HOME
Footings I Setbacks Gas t Piping By Ribbons
irtte'-sorDate By Interior-Date By Date gy
Exterior Date By Exterior-Date By Set-up
Point Load I Isolated Footings INSULATION Date B}
Rate ByBG i SLAB INSULATION
Qata By
FIRE DEPARTMENT_ DE T T
Foundation Walls Floors Gate By
Date By Data By DECKS
FRAMING Walls Dale By
Date By Date By PROPANE TANKS
PLUMBING vault Date By
Date By OTHER
Groundwork ` Attic t
Type:
Date By
Date BY Date B
DRYV4IALL y
D.W.�t Type.
j int Brace Wall Mats By
Date By G Date Sy —
FINAL INSPECTION
Water Line Fire Seperaation
Date By Date B} Date By
Pass or Request Inspect.
Type of Insp. Fail Date Date Dome By Comments
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