HomeMy WebLinkAboutDerelict Bldg - BLD Letters / Memos - 4/25/2016 Case Number: N�� —060(0 Z
Mason County Investigation Report Form
Parcel Number: 11310 -5 1 -
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Violation Site Address: n6 21 N E (.6.4,9-✓l A I D I��-'c.K'w'f2"
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Property Owner(s): 1• \/1'Yj 'rht.hw _ Phone#:
Mailing Address: son!S� 0' QJI Oy Q,
Tenant/Contractor/Operator on site: OVA)KUL
Directions to Site: N Oe-6N IZ d P_ Sa' 1 t t 11 12
Description of Concern: Lk�
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 if you 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:
❑ Please do not disclose my identity. I 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 k
Complaint Received by: t-7 AprDate:
Complaint Received by: ❑ Phone ail ❑ Web Site ❑ In Person
Department of Concern: \J&Ruilding ❑ Planning ❑Fire ❑ Public Works
Environmental Health: ❑ Solid ❑ On-site ❑ Wells ❑Food ❑ Other
Investigation Date and Findings:
Date Closed: Reason Closed: Initials:
0N COU MASON COUNTY (360) 427-9670 Shelton ext.352
DEPARTMENT OF COMMUNITY DEVELOPMENT (360) 275-4467 Belfair ext. 352
BUILDING•PLANNING•FIRE MARSHAL (360)482-5269 Elma ext. 352
Inspection Hotline (360) 427-7262
-: Mason County Bldg. 8, 615 West Alder Street
Shelton, WA 98584 www.co.masonma.us
CORRECTION/INSPECTION REPORT
PERMIT/CASE NUMBER: � .J #'2p t b —00 0(o Z
ADDRESS/LOCATION: 5-2- ( N Lo.✓Sd
FINDINGS•
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Items listed above must be corrected to gain compliance.
❑ THIS IS NOT A COMPLETE INSPECTION
❑ This structure has been inspected by Mason County Building Department and the items listed
above are in VIOLATION of Mason County laws and/or ordinances.
❑ Call for re-inspection when corrections are made before proceeding with any further work.
❑ Make corrections, items will be checked on the next inspection.
❑ OK to
Date: Please contact our office regarding possible
Department: &-t> structural damage incurred by recent
inspector:—. "natural/man made"disasters.This is NOT a
CORRECTION NOTICE.
DO NOT REMOVE THIS TAG
MCC14.12