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HomeMy WebLinkAboutCOM2000-00068 Cleaners - COM Permit / Conditions - 10/31/2000 MASON COUNTY PERMIT ASSISTANCE CENTER Inspection Line (360)427-7262 Mason County Bldg. 3 426 W. Cedar P.O. Box 186 Phone: (360)427-9670, ext. 352 Shelton, WA 98584 i COMMERCIAL BUILDING PERMIT COM2000-00068 OWNER: BELFAIR CLEANERS RECEIVED: 06/12/200 CONTRACTOR: OLYMPIC CLEANING EQUI ISSUED: 10/31/200 SITE ADDRESS: 23969 NE STATE ROUTE 3 SUITE I BELFAIR EXPIRES: 04/30/200 PARCEL NUMBER: 123294190021 LEGAL DESCRIPTION: TR 2-A OF NE SE TR A OF SP#423 PCL 1 OF BLA 98-58 PROJECT DESCRIPTION: DIRECTIONS TO SITE: CLEANERS 23969 NE ST RT 3 SUITE I General Information Construction & Occupancy Information Type of Use: Insp. Area: No. of Units: Type of Constr.. 5-N Type of Work: NEW Fire Dist.: 2 No. of Bathrooms: Occ. Group: B Valuation: No. of Stories. Occ Load: 37 Building Height: Pre-Manufactured Unit Information Square Footage Information Make: Length: Lot Size: odel: Width: Building: 1,200 Year: Serial No.: Basement: Parking Spaces: Setback Information Shoreline & Planning Information Front: Ft. Shoreline: Ft. Rear: Ft. Slope: Ft. Water Body: Shoreline Desig.: Side 1: Ft. SEPA?: Comp Plan Desig. Side 2: Ft. Fire Protection System Information Auto Fire Alarm System?: Emergency Key Box?: Standpipe?: Auto Fire Sprinkler System?: Access Road?: Fire Extinguishers?: Fixed Fire Suppression System?: Fire Hydrants?: Fire Lanes?: COM2000-00068 Please refer to the following pages for conditions of this permit. 1 of 3 CONDITIONS FOR COM2000-00068 1) 4CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENT AND UNIFORM BUILDING CODE.x � ) 2) Changes to approved building plans that affect compliance to the current non-residential Energy Code (NREC), ventilation and Indoor Air Quality Code (VIAQ) Uniform Building/Plumbing/Mechanical Codes and/or Mason County Regulations shall be approved prior to construction. X T K 3) ALL CONSTRUCTION MUST MEET OR EXCEED ALL LOCAL CODES AND UBC REQUIREMENTS AND OCCUPANCY IS LIMITED TO THE PERMITTED AND APPROVED CLASSIFICATION. ANY CHANGE OF USE OR OCCUPANCY WOULD RESULT IN PERMIT REVOCATION. CHANGE OF USE MUST BE APPROVED PRIOR TO CHANGE. x 7T K 4) The approved plot plan is required to be on-site for inspection purposes. If inspection is called for and plot plan is not on site, Approval WILL NOT be granted. In addition, a Re-Inspection fee in the amount of$42.00 per hour(minimum 1 hour) will be charged and must be collected by this department prior to any further inspections being performed or approval granted. X ;TIC 5) All approved plans are required to be on-site for inspection purposes. If inspection is called for and plans are not on site, Approval WILL NOT be granted. In addition, a Re-Inspection fee in the amount of$42.00 per hour (minimum 1 hour) will be charged and must be collected by this department prior to any further inspections being performed or approval granted. X 7�__ 6) PURSUANT TO 1997 UNIFORM BUILDING CODE, ALL SITES MUST HAVE APPROVED NUMBERS OR ADDRESSES PROVIDED IN SUCH A POSITION AS TO BE PLAINLY VISIBLE AND LEGIBLE FROM THE STREET OR ROAD FRONTING THE PROPERTY, MASON COUNTY BUILDING DEPARTMENT REQUIRES THAT THIS BE COMPLETED PRIOR TO CALLING FOR ANY SITE INSPECTIONS. A REINSPECTION FEE, BASED ON RATES AS ADOPTED BY THE JURISDICTION AND THE 1997 UNIFORM BUILDING CODE WILL, BE ASSESSED IF OWNER/CONTRACTOR FAILS TO POST ADDRESS ON SITE PRIOR TO REQUESTING INSPECTIONS. X 7 7) Approved per dimensions and setbacks on submitted site plan. X 1� 8) The applicant acknowledges that with the proper operation S irn nd cleaning equipment, water quality is not to be degraded as a result of this business use. X COM2000-00068 Please refer to the following pages for conditions of this permit. 3 of 3 Plumbing Fixtures Mechanical Fixtures FEES Type Qty. Type Qty. Type By Date Announ Receipt Water Heaters 1 Additional Fixtures 1 Building Permit Fee SKM 09/14/200 $212.00 54968 Clothes VVas r3r 1 Gas Outlets 4 Building State Fee SKM 09/14/200 $4.50 54968 Mechanical Fee SKM 09/14/200 $18.65 54968 Mechanical Base Fee SKM 09/14/200 $22.00 54968 Plumbing Fee SKM 09/14/200 $14.00 54968 Plumbing Base Fee SKM 09/14/200 $20.00 54968 Non-Res. Energy Code DLC 09/14/200 $42.00 54968 Planning Review Fee AHB 09/28/200 $65.00 54968 EH Plan Review CEW 10/11/200 $50.00 54968 Total $448.16 This permit becomes null and void if work or construction authorized is not commenced within 180 days, or if construction or work is suspended for a period of 180 days at any time after work is commenced. Evidence of continuation of work is a progress inspection within the 180 day period. Final inspection must be approved before building can be occupied. OWNER OR AGENT: DATE: D / ° " D CASE NOTES FOR COM2000-0006 1) COM2000-00068 Please refer to the following pages for conditions of this permit, 2 of 3 CONCRETE MECHANICAL MOBILE HOME Foofngs-Setback date by Ribbons da by Gas Piping date b I; Foundation`halls date by Set Up I date F3 Insulation by INSULATION date by BG/SLAFloors Final date by by date by date by Walls FIRE DEPT. date PLUMBING by date by date by Attic OTHER Groundwork date by date by D.W.V. WALLBOARD NAILING date by date by Water Line FINAL INSPECTION date by date by date by I _ � SAk, "AS /ui� <-Kc .12 /►YS e�J lc�i!/ �E OAer t, 5 f-ram p Building Permit # MASON COUNTY BUILDING 111 426 W. CEDAR SHELTON, WASHINGTON 98584 (360) 427-9670 CORRECTION NOTI E Job Location �� /i> This structure has been inspected by Mason County Building Department and the following VIOLATION of County Laws and Ordinances has been found: Items Listed below must be corrected to gain code compliance ,,;��✓/C✓ F�/s �/ C % C �,Srr®�/-' c.S�i�l� /�-s D,�i� /�o�i jY✓G- � You are hereby notified that the above corrections shall be made BEFORE PROCEEDING WITH ANY FURTHER WORK ❑ Call for re-inspection when corrections are made before continuing ❑ Make corrections, items will be checked on next inspection C ' )01,-, nc�i c ❑ This is not a complete inspecti6V Department Date Z 'S U Inspector 0100 NOT MOOV T H I mob, T " ,� Building Permit #��'"�2 —�C�MASON COUNTY BUILDING 111 426 W. CEDAR SHELTON, WASHINGTON 98584 (360) 427-9670 CORRECTION NOTICE Job Location _-- �� This structure has been inspected by Mason County Building Department and the following VIOLATION of County Laws and Ordinances has been found: Items Listed below must be corrected to gain code compliance I� /n�f'7�LC �S'FC� - Csr�s'ii✓f� /��rc�'��D�c- Y ©�-- ,C3oi�Ei� L ry C C <!" �� �c-c- c/� CAS Y� �c=�J i� ,�c�✓cci sct��tea- �O�/� ,T�,,,��— An— Zh/c.e/2 -,,enc cJ� 6 / so c� �- �/r/f �S'cri�Tc��.✓l .Y d�� � f',O � ,Fi9 . i' 07� QCC�p�r-'cY �I,�'rO�'/�}/`��'?�-cS' � �/ /-" GG'�GGOi� �•� You are hereby notified that the above corrections shall be made BEFORE PROCEEDING WITH ANY FURTHER WORK ❑ Call for re-inspection when corrections are made before continuing ❑ Make corrections, items will be checked on next inspection OK to , y �/ ❑ This is not a complete inspection Department �-,0 Date S--Z G' Inspector /722. ■ �� NnT " ,� �I��lu I L CLCAIIIE ,� , i FORM MUST BE COMPLETED IN INfC PERMIT NO PLEASE PRESS HARD MASON COUNTY BUILDING PERMIT APPLICATION 426 W.CedarlP.cl lox 186,Shelton,WA 98584 Shelton 160 427-9670 Bellair 360 275-4467 Elma 360 482.5269 Seattle 206 464.696e APPLICANT INFORMATION CONTRACTOR INFORIV- TI N �T Owner Contractor Name Mailing Address Z e-. C L'lJ l / Mailing Address City State j&Z& Zip Code :;;s City State _ Zip Code Phone 2( -5-h) O ther Pt). >77 j q-:Z:S Ph.(_•^) _Oilier Ph.(___.•__) Lien/Title Holder 2 S2q -�3SZt Contractor Reg # Address Expiration / / SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Seplic Connect to sewer System Name of Sewer Sys fill Well Water Systcrtl Name of Water Systern ^ PARCEL INFORMATION-12 digit Ta arcel No. Legal Description _ -- - Site Addrer;r;(Please include :beet na c, treral nlfrnbar quit cilY) -- DDiey&tLctio Will timber be out zfnd so in-parcel p eparation? (Yr.r./No)_ _ 1s your property within 200' of the following: Body of Watt:r (Name) Saltwall'r Lake River/Creek Pond Wetland Seasonal Runoff Strearn Slopes or Bluffs TYPE OF JOB New ,��Add� Alt Repair Other' Use of Building _. Describe Work } I ro No. of Bedrooms Nb. of Bathrooms -SQUARE FOOTAGE-1st Floor_ 2.nd Floor 3rd Floor Lott Bast'rnent_ ___ Der;k__ -_Other_-• _. sq. It- , Cartage Attached Dctalched Carport Attac.:hed Dctachrlt MOBILE HOME INFORMATIO - e. e__ Model Year, Length Width Serial No` --.--No. of Bedrooms No. of Bathrooms�— Type of Heat _•- P ase Price S __ R?placement Unit ?(Yes/No)Installer Name cation No. --- NOTICE: THIS PERMIT 6ECOMES NULL K VOID IF WORK OR CONSTRUCTION AUTHORIZED IS MMENCED WITHIN 180 DAYS OR IF CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 100 DAYS AT ANY TIME AF E WORK IS COMMENCED- PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf, represents that the Information provided is accurate alld grants ern PIUyees of Mason County access to the above described properly,%l1d ctruclures for review and inspection of this pru}ect. Acknowledgment of such rs Uy cignalure below: OWNER AFFIDAVIT-]certify that I an,exemPt from the requirernenls of the CONTRACTOR'S AFFIDAVIT-I certify Ihai I am currently registered as a contractor Registration Law RCW 18,27 and am aware of the wdinancp contractor to the State of Vtrushington and Ihal I an,aware of the ordinance requirements for which this ill is- sued and that all work will be done to re-qurrervients regulatutg the work for which this permit is i9sllert and all work conformance therewith- o than s hall ba without first ublaining shall be done Irl conror a therewith U Changes shall Ua made.without approval first obtaining ap a. 7 X rz �(-� -..l __ _ Dafe t' V _ __Daly'J��- FOR OFFICIAL USE BEYOND IS POINT Accepted by Date Submittal Arnount Due Re(;Ptpt No. DEP^!C TMENTAL REVIEW APPROVED :.DE,NI)E D CONDITION CODES Building Department Occ Group _ Type Constr. � _ �-5►��� Planning Department Environmental Healtft Depatrtment Public Works department Fire Marshal Valuation 5 >..a' Frmit Fee Site Inspection w Fee LIFC Plan Review Fee Base Fee Public Works Revie Fee Mechanical & Base Fee Other Wond/Gas/PPIIet Stove Fee Other Violation Fee Pre-Pslid at Submittal ) k TOTAL FEES =IOT = zT 00-E0-/C1l2W May-23-00 O1 = 04P �/ I, -�01/�y�� • FORM MUST BE COMPLETED IN INK P F R M I T NU Oita PLEASE PRESS HARD MASON COUNTY BUILDING PERMIT APPLICATION 426 W.Cear/P.O.Box 186,Shelton.WA 98684 Shelton 760 427-9670 Belfa.rd 360 275�467 EIrna 360 462-6269 Seattle 206 464.6968 APPLICANT 1 FORMATI _ CONTRACTOR INFORN� ION Owner d/ L % !l/�i 1 Contractor Name L7f�Jl/� Mailinc Address rJ /G Mailing Address City LL114 State Zip C e City State Zip Code Phone(7e.7,) c>2-q —I-iObther Ph. �,1: �i��— lxZ Ph.�_) Other Ph ( ) Lien/Title Holder Contractor Reg._# _a;,&. ►Qc:-� Address Expiration 40�i- l n 1_ SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer Systern Name of Sewer System Well Water System Name of Water Systern oil z: ARCEL INFORMATION-12 digit Ta,* arcel No, -:W. J qQgza 7 Fire District Legal Description / oZl9 A/47 0 Site Address(Please include street name, street nurnbcr and cil)ex r,. "_ y ,- Directions to site flz�2 Will timber be cut and sold in parcel preparation? (Yes/No) Is your property within 200' of the following-. Body of Water (Narne) Saltwater Lake River/Creek Pond Wetland- Seasonal Runoff Stream Slopes or Bluffs PERMANENT RESIDENCE O SEASONAL RESIDENCE CQ TYPE OF JOB New Add, It Repair Other Use of Building Dcrw No of`$edi of's No. of Bathrooms SQUARE FOOTAGE-1st Floor 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached Carport Attached Detached MOBILE HOME INFORMATION-Make Model Model Year Length Width Serial No, No. of Sedrooms No. of Bathrooms Type of Heat Purchase Price 5 Replacement Unit ?(Yes/No) Installer Name Ceitificalion No. NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 190 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS of A PROGRESS INSPECTION. Tile uwner or agent on owner's behalf,represents that the inlurmation providad Is accurate and grants employees of Mason County access lu the above described property.Utd structures for review and inspection of this project. Acknowlerdgment of such is by signature Below: OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I certify that I ani currently regisieri a as a Contractor Registration Law RCW 15.27 and am aware of the ordinance contractor in the Slate of Washington and that I am aware of the ordinance requirements for which this permit is issued and that all work will be done in requirements regulating the work to' Slch(his permit is issued and all work conformance therewith--Wo changes shall be made without first obtaining shall be done in confornianc�Jth• CWith. No changes shall be made without approval. / .. C �+ first otlainin appPova� X / / / Date L`-- ���_FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal AfIIOunt Due Receipt No. DEPARTNLENTAL R :VIEW AP.PF;ovEfa':':DENIEO_ :: '. :CC?.N.D.I71L7N CODES Building Department PlanOcc ning Type Constr. Pla Planning Department Environmental Health Department V Public Works Department I Fire Marshal Valuation S <r :..,� .5 Building Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee Plumbing & Base Fee Public Works Review Fee Mechanical & Base Fee Other f✓ Wood/Gas/Pellet Stove Fee Other Violation Fee Pre-Paid at Submittal r ( ) R TOTAL FEES o W`Rl� ?`: ;vlay-23-00 01 04P I- - OZ •FORM MUST BE COMPLETED IN INK PERMIT NO - C0147 2,SOl7-rrXD 0 PLEASE PRESS HARD MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATION 426 W.CedarlP.O.Boi 186,Shelton.WA 98584 Shelton 360 427-967D Belfalr 360 2754467 Elma 360 4825269 Seattle 206 464-6968 APPLICAI INFORMA710,IV CONTRACTOR INFORMATION Owner �( v` ?r L <_ .��-c ivt r'y r< , L.c�',�. �- Contractor Name Mail Addre s �- -.'I �/07 Mailing Address city Zip Code Y. C'd: City State Zip Code Phone( `;0,,) �=,J-�1 I:�L'10ther Ph_( Ph.( ) Other Ph-( ) Lien/Title Holder Contractor Reg. # Address Expiration / / SEPTIC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION-12 digit Tax Parcel No. ! / Fire District Legal Description Site Address(Please include street name, street number and city) Directions to site Is your property within 200' of the following: Body of Water (Name) Saltwater Lake River/Creek_ Pond Wetland Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB New Add Ali Repair other Use of Building Location of Fixtures/Units 15t Floor 2nd Floor Basement Garage Closet PLUMBING FIXTURES(Show Number of each) N AL UNITS I Type: Electric Type of Fixture No. of Fixtures Fees atural Gas Heatpump Toilets yDe o nit No. of Units Fees Bath Basins Furnace Bath Tubs T ane ank Sinks ;— F77 Dishwasher OtherOtherBase Fee :.— Bast: FeeTOTAL PLUMBING MECHANICAL A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF FIXTUREIUNIT- NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the information provided Is accurate and grants employees of Mason County access to the above described property and structures for review and Inspection of this project. Acknowledgment of such is by signature below: I OWNER AFFIDAVIT-1 certify that 1 am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT•I certify that I am currently registered as a Contractor Registration Law RCW 16-27 and am aware of the ordinance contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit I§§issued and that all work will be done in requirements regulating the work for which this permit is issued and all work conformance therewith-�No cha s shall be made without first oblalnmg shall be done in conformance ther�awlth. No changes shall be made without approval. first obtaining ap-yrovat. / �• _ r r Xrr�. Date il / �.l Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. ;t:-:DEFAR7MffiTlTAL'REVIVY :,.:';:'< 'APAKdVIwR ..'.'.DENIED.... Building Department Occ Group Type Constr. Planning Department Other TT Other Permit Fee Site Inspection^ Plan Review Fee UFC Plan Review Fee Plumbing&Base Fee Other Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal ( ) Violation Fee TOTAL FEES LFA CIf-A1vE1Z.S FORM MUST BE COMPLETED IN INK r=RMI I Nr; ,G!C�� PLEASE PRESS HARD MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATION 426 W.Cedar/P.O.Box 186•Shelton,WA 92594 S trclton(360)427`-9670 Belfair(360)2754467 Elrna 360 d82-6269 Seattle APPLICAN (206)a64b96B INFORMATION - ) CONTRACTOR INFO V) TION Owner �i�E�G� Contractor Name I t Z�i1 L� OW lin ddres � - L^ Mail Address-a. J ' City ✓ Stale Zip Code City .t - State Zip Co e > Phone( �) %� l �pther Ph.O Ph_ 'C 7� ) r� - Other Ph. ?- C l Lien/TiIle Holder _ Contractor Reg. # - Address Expiration _Dq' SEPTIC INFORMATION-Connect to New Septic _Existing Septic Connect to Sewer Systcr�fJame of Sewer System PARCEL INFORMATION-12 digit Tax Parcel No / / _,_ Firr. District—- Legal Description Site Address(Please include street name, street number and city) Directions to site Is your property within 200' of the following. Body of Water (Name) Saltwater — Lake River/Creek Pond Wetland Seasonal Runoff Strealn--Slopes or TYPE OF JOB New Add Alt Repair Other Use of Building Location of Fixtures Units 1 st Floor 2nd Floor Basement Gelral)e__..,t-Ir>set PLUMBING FIXTURES(Show Number of each) MECHANIC S duel Type. Electric Type of Fixture o. of Fixtures Fees LPG �tttrral Gas HPatpurrtp Toilets Type of Un No_of Units Fees Bath Basins Furnace Bath Tubs Heatpumps Showers Vent Fans -- Water Healer —� Propane Tank -- Laundry Wsher �� Gas Outlets --- - Wood/Gas/Pellet Strive Sinks _ Dishwasher Direct enl,? Other Other Other Other -- - B I — - Bases Fee Base Fee TOTAL PLUMBING L -- TOTAL MECHANICAL J A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF FIXTURE/UNIT. NOTICE: THIS PERMIT BECOMES NULL R VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF I CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED. 1 PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the information provided is accurate and grants employees of Mason County access to the above descrihed property aria strurtrlres I— review and inspection of this project. Acknowledgment of such is by signattire below: �j OWNER AFFIDAVIT-I c:eltify that:am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-1 Certify that t urn r vrre.nlly u_gr.:aererl as a C antraraor Registration Law RCW 1H 77 and am aware of the ordinance rnnhactor in the t3tate of Washington and Irwt I am Rvrorc of the..orYenanW:e requirernents far which this ermit is, ued and that all work will be done in requirements reyulatiny the work free wltlr..h the inges is icyLeed and aft.work conformance therearrtn" chareq !.halt be made t first obtaininn Shall be done in contarmance lh'•rewith J Ilil,lgPs•shall Ur made without approval - first obtaininn approves ' ... / 1J XX ...... __.. _ FOR OFFICIAL USE BEYOND THIS POINT Date_ Subrrlittal Amount Due Reccipt No Accepted by — :.DEt?AftTMEN7ALFG1/.IEW ..-.,:APPROVED -- _ ::G.6NDI•fl PN CODE! �I Building Department Occ Group Type ronstr. Planning Department /u /f1 JJ .. .— Other CCt,� Other --. .._. .—. :: ..j ..- - Site Inspection - Permit Fee - — - UFC Plan Review Few Plan Review Fee - — jeJ- � -- Plumbing 3 Base Kee Oth a�` Other Mechanical 8 Base Fee pre-Paid at Submittal WoodlGas/Pellet Stave Fee '' —� TOTAL FEES y Vwlatlon Fee _ Z0 - d d50 = ZT 00-EO-�eW 0 BELFAIR CLEANERS 0 PHONE 253-529-1301 FAX 253-529-1 302 CSCALE, I' = 1/4' IWA" Br- DATC- 5/4/2000 0. KIM OLYMPIC. INC. OLYMPIC CLEANING EQUIPMENT CO. ! 3' DRA[H a Ex7 S�]►iG -- FLOUR SIN( r Vi CF!PRESSQ. BOvN aj 51 C 'B ! � � �� Q E :,IpNF ®RERN 3 u .i ' A CDNVEY❑R :�)yVOl k 15 AFSP f s v -- ! r=? r a o BGDY PRESS 1 PHALC i M fA. r l �� 110 VtJLT ��a �' I a �• 3 PHA E 1 [ 77:= ID R -- EI 2 Cc- :c0 'E-� T ' 1 PR ACE C A COLLAR & BUFF i ]k0 VOLT Sd R-j rL— �3y/ !0 AMP P-4AGE ❑�'� a'••' EXISTING BDILtR F-. QM `20 VOL r I r LJJ J a. Z in � m u o> > lakes E Q IIOVQLI v= ti ! 101NAP lPFifktC EXISTING RESTROOM �k¢ I (0 IDAW �J a O cl SPOTTIWG BOARDCL 4: A < 4Sd �tt 1 < / 119vOLi V i A 0 LEGGER PRESS :� I V i A INVESTIGATION REPORT FORM f�F ��b 3 9 Revised 01/22/03 [rJ Part A: Nature of Complaint • Initiator's Name: • Address: • Telephone: • Owner Name: e.¢,(G-� +� � S7/ � y • Address: CPTS • Telephone: • Department of Concern qHealth Clerical ❑ Building Ukomm Development ❑ Fire• Area of Concern: ❑ Process Delay ❑ Personnel ❑ Policy/Fee ❑ Code Violation ❑ Other Refer to Director • Location of Concern: ,ef Z- 3� l� y 5 T. 4z T-. 3 ,A• Site Address n • Nature of Concern: ON e9M 2.600 --Q002 p. • DOES COMPLAINTANT WANT TO REMAIN ANONYMOUS ❑ Yes ❑ No Part B: Concern Intake and Referral Received By: Referred To: Response Date: till �03 et F ;212s/v3 � Name Date Name Date Date 00 Part C: Findings Referral Forwarded to: ❑N/A Name Date Findings:' 242 e/ 0 3 - K-ej _J/ P 1 G K A-a,-, p tl ,,% . u-4 (-,- � r o M a-cm z ®U f S 7 , C'uN..�2._Q.�,�e d �.�t o�-�c-[., ,. . a OLo , Part D: Resolution / /+ C.1-t Cl crz) 3 — U 0 a y C-(o s-0 d w 8 a C vw• f 1 - n- < <k u e- U f Name Date Intake Copy-White File Copy-Yellow FIRE & LIFE SAFETY INSPECTION: STATEMENT OF DEFICIENCY & CORRECTIVE ACTION FACILITY ADDRESS CITY ZIP PHONE NAME —Ak04'*A. - 'k-v , ,: _ '.�{ ' INSPECTOR AGENCY DATE DAVE SALZER 360-427-9670 X-273 MASON COUNTY FIRE MARSHAL FD `4 ITEM STATEMENT OF CODE OR WAC CORRECTIVE ACTION CORRECTION NO. DEFICIENCY REFERENCE REQUIRED REQUIRED BY DATE vvv Q a W 00 Ln `o00 LL a � c 0 c Z 04 t N � 0 - SON ) rn L w Z > N O n 0 =O COP Q C m 0 0 THE DEFICIENCIES DESCRIBED ABOVE HAVE BEEN SIGNATURE / REINSPECTION DATE EXPLAINED TO ME, AND I AGREE TO MAKE CORRECTIONS NO LATER THAN THE DATES INDICATED PAGE OF PAGES White Copy: Occupant— Yellow Copy: Fire Marshal— Pink Copy: Fire District