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HomeMy WebLinkAboutBLD2008-00832 Cancelled Complete Construction from BLD28784 - BLD Permit / Conditions - 12/7/2023 Inspection Line(360)427-7262 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670,ext.352 Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton, WA 98584 RESIDENTIAL BUILDING PERMIT BLD2008-00832 ' OWNER: PAT HASKELL RECEIVED: 7/7/2008 CONTRACTOR: LICENSE: EXP: ISSUED: 9/29/2008 SITE ADDRESS: 565 E MIKKELSEN RD SHELTON EXPIRES: 3/29/2009 PARCEL NUMBER: 321341390050 LEGAL DESCRIPTION: TR 5 OF SW NE S 8/32 LOT: 2 SP#783 PROJECT DESCRIPTION: DIRECTIONS TO SITE: Complete Construction of SFR. HWY 3 TO MASON LAKE TOWARD LAKE LIMERICK RIGHT ON MIKKELSEN RD .5 MILE TAKE LEFT GO TO END OF DIRT ROAD. General Information Construction&Occupancy Information Square Footage Information No. of Bedrooms: 4 Type of Constr.: V-B Type of Use: SF Insp.Area: No. of Bathrooms: 3 Occ. Group: R-3, U-1 Lot Size: Deck: Type of Work: NEW Fire Dist.: 5 No.of Stories: 3 Occ. Load: Building:2,582 Garage-Attached 598 Valuation: Building Height: Occ. Status: Basement:992 cov. decks 272 Manufactured Home Information Setback Information Shoreline& Planning Information Make: Length: Ft. Front: Ft. Shoreline: Ft. Water Body: SEPA?: Model: Width: Ft. Rear: Ft. Slope: Ft. Shoreline Desi Side 1: Ft. g.. Year: Serial No.: Side 2: Ft. Comp. Plan Desig.: Plumbing Fixtures Mechanical Fixtures FEES Type Qty. Type Qty. Type By Date Amount Receipt Dishwasher 1 Exhaust Hood 1 Building Pre-Site Inspection KKK 7/7/2008 $68.00 S22008000 Kitchen Sink 1 Furnace<100K 2 Building Pre-Site Inspection KKK 7/7/2008 $68.00 S22008000 Lavatories 3 Gas Outlets 4 EH Plan Review KKK 7/7/2008 $40.00 S22008000 Showers 1 Propane Tank 1 Building State Fee RTB 7/24/2008 $4.50 S12008000 Water Closets (Toilets) 3 Ventilation Fan 3 Mechanical Base Fee RTB 7/24/2008 $26.60 S12008000 Water Heaters 1 Woodstove 2 Plumbing Base Fee RTB 7/24/2008 $23.10 S12008000 Bath Tubs 2 Dryer Vent 1 Building Permit Fee RTB 7/24/2008 $1,307.05 S12008000 Clothes Washer 1 Mechanical Fee RTB 7/24/2008 $270.90 S12008000 Plumbing Fee RTB 7/24/2008 $77.30 S12008000 Plan Check Fee RTB 9/16/2008 $612,00 S12008000 Water Adequacy Plan Review PJO 9/24/2008 $40.00 S12008000 EH Plan Review PJO 9/24/2008 $60.00 S12008000 Total $2,597.45 BLD2008-00832 Please referto the following pages for conditions ofthis permit. 1 of 5 CASE NOTES FOR BLD2008-00832 CONDITIONS FOR BLD2008-00832 1) All other necessary permits from Mason County, Washington State and/or Federal Agencies that are r_equir d for thi proposed development and construction must be obtained PRIOR TO SAME DEVELOPMENT AND CONSTRUCTION. X , 2) Contractor registration laws are governed under RCW 18.27 and enforced by the WA State Dept of Labor and Industries, Contractor Compliance Division. There are potential risks and monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at 1-800-647-0982. The pers n signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law. 3) All approved plans are required to be on-site for inspection purposes. If an inspection is called for and plans are not available on site, then approval will not be granted. In addition, a re-inspection fee(refer to current fee schedule, minimum 1 hour)will be charged and must be collected by the Building Department p rior to any furth inspections being performed or approvals granted. �Jr__ 1 4) Owner/Agent is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28. X Xv- 5) The plan review check list and corrections are part of the approved plans and must remain thereto. It is the responsibility of the applicant to make the corrections indicated on the plans. Once the plans are marked "APPROVED", they shall not be changed or altered without authorization from the Building Official. The permit holder is responsible to retain the complete approved set of plans on site for the duration of the project. Failure to comply and/or removal ofapproved do �nts ill result in failure of required building inspections. �z' 6) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X 7) Washington State Energy Code Compliance has been approved using the following: Heat Type: Electric or other fuels, Compliance Method: Prescriptive option IV, Window(Max U-Factor):0.35, Skylight(Max U-Factor):0.58, Doors (Type/Max U-Factor):0.20 or less, Wall insulation R-21, Floor insulation R-30, Ceiling Insulation R-38, Vault Insulation R-38 (see exception), Slab Insulation R-10. Exception: R-30 insulation may be installed, up to 500 sq. ft., in single rafter or joist vaulted ceilings where the distance of the top of the ceiling and the underside of the roof sheathing is less than 12-inches and there is 1-inch vented airspace above the insulation. X lL� BLD2008-00832 Please referto the following pages for conditions of this permit. 2 of 5 8) Concrete used for basement walls, foundation walls, exterior walls, porches, carport slabs, steps exposed to the weather, garage floor slabs and other vertical concrete work exposed to the weather shall have a minimum compressive strength of 3000 psi(IRC Table R402.2). X ff ea 9) Any changes in proposed construction shall be reviewed by the engineer or architect of record and submitted in writing to the Mason County Building Department prior to construction. All engineering and/or architectural documents are a part of the approved set of plans and shall remain attached thereto. If documents are removed, approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be X charged and shall be collected by the Building Department prior to any further inspections being performed or approvals granted. 10) All construction must meet or exceed all local ordinances and the international codes requirements as adopted and amended by Mason County and the State of Washington. Occupancy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in permit revocatisn/� X 0 11) Provisions for surface/subsurface drainage control must be implemented with new construction or development on site and MUST NOT adversely impact adjacent parcels. Under the requirements of Mason County Stormwater Ordinance, either private ditches and drains will meet requirements of the stormwater ordinance or prior approval will be granted to use an existing utility and drainage easement dedicated for that specific purpose. For further information regarding this ordinance and the REQUIREMENT to obtain an ACCESS PERMIT for the installation/construction of a driveway or access connecting from a Mason County Road, Contact the Mason County Public Works Department prior to construction at Ext 450. For any construction which is proposed to be located within 25' of a Mason County road right of way, it is suggested to contact that office to review future planned work which may affect your project. X Pir#_ 12) All changes to"approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County X rdinance or regulation must be reviewed and approved by Mason County prior to construction. �d- 13) CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENT AND THE ADOPTED BUILDING CODE. The construction of the permitted project is subject to inspections by the Mason County Building Department. All construction must be in conformance with the international codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building Inspector shall be made prior to requesting additional inspections. X 14) All propane tanks must be installed in accordance with the International Fire Code and all applicable Mason County ordinances. All propane tanks filled on site must be located a minimum of 10' from any possible source of ignition (electrical outlets, electrical fixtures, compressors, etc), mechanical system air intake(direct vent appliance, ventilation air intake, etc), and/or any weeds, grass, brush, trash or any other similar combustible materials. Propane tanks less than 125 gallons must also be located a minimum of 5'from any building opening (foundation vents, windows, doors etc). Setback to the public way, or access easements shall be the greater of 25-ft or as specified in the Mason County Development Regulations. Setback to property lines shall be the greater of 5-ft or as specified in the Mason County Development Regulations. If a propane tank is exposed to probable vehicular damage, protective bollards must Ilan installed. X 4� BLD2008-00832 Please referto the following pages for conditions of this permit. 3 of 5 15) All propane tanks must be installed in accordance with the International Fire Code and all applicable Mason County ordinances. All Propane tanks between 125 and 500 gallons must be located a minimum of 10' from any building, possible source of ignition (electrical outlets, electrical fixtures, compressors, etc), and/or any weeds, grass, brush, trash or any other similar combustible materials. Setback to the public way, or access easements shall be the greater of 25-ft or as specified in the Mason County Development Regulations. Setback to property lines shall be the greater of 10-ft or as specified in the Mason County Development Regulations. If a propane tank is exposed to probable vehicular damage, protective bollards must be installed. X 6T,_� 16) All propane tanks must be installed in accordance with the International Fire Code and all applicable Mason County ordinances. All propane tanks must meet the in�ta anon requirements and minimum setbacks as listed in the Mason County Fire Marshal's Standards for the Installation of Propane Tanks. X �l�{JJ — V & , 17) Fuel piping shall be inspected after the installation of fuel piping is complete, and before the attachment of fixtures, appliances, or shut-off valves. At the time of inspection the test pressure shall be no less than 10 psi held for no less than 15 minutes. Appliances to be attached to the fuel piping system shall not be used until the final inspection has been performed and approved by a Mason County building inspector. X f :, Oa= 18) The placement of small propane tanks are not normally subject to a permit review by the Planning Department; however, propane tanks are subject to Planning Department regulations. Such regulations primarily consist of setbacks from shorelines and features considered to be critical areas (streams, wetlands, slopes, etc.) If you think such features 9xist on or nearby your property, please contact the Planning Department so that exact setback requirements can be determined. X 19) All building permits shall have a final inspection performed and approved by the Mason County Building Department prior to permit expiration. The failure to request a final inspection or to obtain approval will be documented in the legal property records on file with Mason County as being non-compliant with Mason County ordinances and building regulations. X V r4,�L 20) All permits expire 180 days after permit issuance, or 180 days after the last inspection activity is performed. The Building Official may extend the time for action for a period not exceeding 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit (older have prevented action from being taken. No more than one extension may be granted. 21) Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners, connectors, and flashing. Install metal connectors approved for contact with the new types of pressure treated material. X iPG 22) By definition, propane tanks and heatpumps are structures, which must meet setback conditions. Please check your"Approved Site Plan"to ensure these structures meet the setback conditions listed. X 6e — 23) Landings and stairs must meet the same setback conditions as any permitted structure; and, must be shown on your site plan. Please check your "Approved Site PI n"to ensure these structures are shown and meet the setback conditions listed. X 4a �T--T BLD2008-00832 Please referto the following pages for conditions of this permit. 4 of 5 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 anytime 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. Proof of continuation of work is by means of a progress inspection.The owner or the agent on the owners behalf, represents that the information provided is accurate and grants employees of Mason County access to the above described property a ructure for review and inspection. 9 OWN ER OR AGENT: DATE: BLD2008-00832 Please refer to the following pages for conditions of this permit. 5 of 5 Codan building code U construction consulting Since 1 P64 Ralph 1). Provencal, Consultant 1221 Frederick Ln NE- Olympia- WA-98506-4710 Voice: 360.753.5082 Fax: 360.528.6759 August 13, 2008 Building Department Mason County Re: Professional Services Haskell project 565 Mikkelsen Rd Shelton WA Due to a severing of the relationship between myself and the Haskells with respect to this property,without them completing payment for my services, it is necessary for me to withdraw my work from the permit application package submitted by the Haskells to your department. This is a matter of professional liability for me, as they are not entitled to use my work without payment. The specific documents I refer to are: -Page A I, rafter supports, an 8.5 x 11 page -Page titled `Residential Letter of Certification', certifying the site built wood trusses -Page titled `Residential Letter of Certification', certifying the garage wing concrete foundation I apologize for the inconvenience to you, and request return of these documents to me. I will pick them up from your office. Sincerely Ralp DP Forensic Architect i l�jr►o/ L����iy �X� �3 � � I ,i ,� P/ JCS G7r i 17 f li nclel i Sow V e c 9&x, I! 1,. ill I 14', 1 a Fk 151,5 ,� � � Fly f 'hem r✓c� 1117 • /"vof' nl� joa.�-fi� 2 ��'fh ofoi7� � r,�ore fr�d v 7 �PtLo?e hour o�� p � Ver �loci slC.°� 7 i 00 'gyp Vey, I MASON COUNTY RESIDENTIAL PLANS SUBMITTAL CHECKLIST Owner's Name: Date: Reviewed By: Documents: Building permit Application Complete STORM WATER WORKSHEET COMP —Planning Intake Checklist Complete —Site plan includes:Allowable building area,roof overhangs,decks,etc. —Fire Apparatus Access Road info required? Yes/No _Energy Code Application Form-O Electric wall heater O Electric central furnace O LPG Furnace O Heat pump with electric furnace O Heat pump with LPG furnace O Boiler(heat type O Other:Specify: —Mechanical/Plumbing Application-WATER HEATER FUEL TYPFJLOcT —Engineering? Yes/No snow load: seismic: PARCEL FILE Stock Plan—approved snow load: Seismic: Manufactured Homes-4 FLOOR PLANS p ` Foundation Type: ANSUManufacture method Engineered footing/foundation Basement Decks: Covered? Uncovered over 4 x 6 and over 30"? Construction plans required. Construction Plans:_3 COMPLETE SETS Plans Legible _Recognized Scale _Elevation Views _Cross Section —Foundation Plan _Roof Framing Plan _Floor Plan-Use of rooms noted(all floors) Floor Framing plan-all floor levels including loft,crawlspace,etc. (<200 S.F.??—stairs?) Cps S Deck Framing Plan,incl cov.porch framing Plan Details: ' —Roof framing details,truss lay-out may be needed Y (Hip and girder location shown) Wall Framing-Does bearing-wall height exceed 10'?(Engineering may be required) _Floor framing: Floor joists: ,Floor beams: —Window headers. Typical header: —Foundation:footing size,reinforcement I vl PA —Concrete Walls-Does Concrete Wall Height Exceed 8'?(Engineering may be required,see details —Landings at all exits?Less than 30"above grade?Y/N —Heated By Furnace-Location of Furnace _ —Fireplace/Stove Information Shown-Fuel Type?_ Locarion(s): _Window Sizes Marked on Plans — Braced wall panels(shear walls)marked on plans? — 2-story garage? (Engineering may be required) I"story of two story D1—45%,D2—55% COMMENTS t 1'Yl O COI c�.i'►'►'1 t'� ENGINEERING RE D BraAwall panelstbrace wall lines are not marked on plans(R602.10) — Amount and location of bracing does not meet minimum required in Table R602:10.1 DESIGN CRITERIA: All notes and details required as a result of the engineered analysis shall be-transferred onto proposed building plans. Wind 85 MPH, Exposure B(unless proven otherwise). Seismic Zone: .Snow_psf. HZREGULAR BUILDINGS R301.2.2.2.2 Irregular portions of structures shall be designed in accordance with accepted engineering practice. A portion of a building shall be considered to be irregular when one or more of the following conditions occur: 1)Exterior braced wall line or BWP cantilevered or offset by more than 4' 2)Roof or floor is not laterally supported on all edges 2A)Portion of roof or floor extend more than 6 fL beyond the braced wall line. 3)End of B WP extends more than 1 ft.over an opening more than S ft in width below. 4)Opening in a floor or roof exceed the lesser of 12 ft.or 50%of the least floor or roof dimension. 5)Portions of floor level are offset vertically 6) Shear wall lines do not occur in two perpendicular directions. 7) When a story above grade is includes masonry or concrete construction(exc:fireplaces,chimneys,and veneer). When this applies the entire story shall be designed In accordance with accepted engineering practice. K\permit tech building checklist.doc Revised 11-30-2007 . 4 T- a / �� Soy G� o%v'1 o u ✓ C� lcs 0.�"1pQ h a3 �x b ' �i N �r>�, 44, Arc �` a n,,w.-4-e1 Lc j' G� h.cf Sj t ► /c t% oti r L J ro v S t ra C✓ n ,f olp.wL f �i av wL'j4 s "1 4 0,1� 1 � 5 p _ yuuu kp— rpDht L4 TO BE KEPT IN THE PARCLL FILE ,,,rw a� *7L .10 - ,�� .��-_ -..yam-. '- �• . -_ - ��._.. -.'- � J_ ,i - V -•�.� � '. Ltd `.. 14 e rti 3 r. t 2 .►'�tk -y �aSt=- r �1 F Pr I9 11 r'• • k fey. k V � A 1 .s. 1. � 11 /14/2005 A a' 1 _ t A'. f � i i mom - _ f :1 �- � � � 1 '` 1 ■ •� ::� � - `. . I .,• .�.`� r i E �� � � .+� � 't a _ j .Y t r�„ - .. a' � � - : _ - - -� _ ". ,.. � - .� � � � - �. ti� ,.� � '� ( � n� 1 O 10/04/2006 I N S i FF �x • fY r` 10 04 2006 MASON COUNTY PERMIT NO. V U BUILDING PERMIT APPLICATION 426 W. Cedar- P.O. Box 186, Shelton, WA 98584 1-0 ID 1J .� Shelton (360) 427-9670 - Belfair (360) 275-4467 - Elma (360) 482-5269 On the web www.co.mason.wa.us ""'�'�e✓iP.c� APPLIC T INFORMATPIN Lu CONTRACTOR INFORMATION Owner t "1' Q"1} TT��t.$j'C B-) Company Name Mailing Address 44 V Mailing Address City State Zip Cod g City State Zip Code Phone — Other Ph. " #fo-34rY Phone Other Ph. Lien/..,itlerK e Contractor Reg. # Exp. E mail address C-LL 14011 QY7s N %CR0 E Mail Address Drivers Lic. # FIA & A y TKMDOB `;-/ -? `C-OM 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 Digit Parcel No. Fire District Legal Description C)-{ 5U) N,- oZ 5 00 JV 7 93. 18 :3 Site Address (Pleas in( Jude street name street number and city) to E r a Piraptiogs to sif I e l III timber be cut and sold in parcel preparation?Yes/ 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 PRIMARY RESIDENCE ❑ SEASONAL ❑ Use of Building f Cam`Describe Work i'; ' No. of BedrogMs LA No. of B hrooms Square Footage- 1 st Floo 5 2nd Floor 3rd Floor to Basement GX Deck— Covered Deck Other Sq. ft. Garage57j,/ Attached — —Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make '� Model Year Length Width Serial No. No. of Bedrooms No. of Bathrooms Type of Heat Purchase Price $ Replacement Unit? Yes/ No 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 informaticn 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 OF -P OGR_ESS INSPECTI~O INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. X !''" ��,o,.�C �G`� Date: Owner/Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW AP ROVED DENIED NOTES Building Department L(lpir Planning Department Environmental Health Department Fire Marshal FEES Building Permit Fee Site Inspection Plan Review Fee ,�a 4a ,00 EH Review Fee Plumbing & Base Fee ja.5 i 30 3- !/J Planning Review Fee Mechanical & Base fee ,��-� • JO Other Wood /Gas/ Pellet Stove Fee ". 0 0 State Fee y Violation Fee • Pre-Paid at Submittal Valuation $ TOTAL FEES MASON COUNTY PERMIT NO. PLUMBING/MECHANICAL PERMIT APPLICATION 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 Shelton (360) 427-9670•Belfair(360)275-4467• Elma (360) 482-5269 On the web www.co.mason.wa.us APPLICANT INFORMATION, CONTRACTOR INFORMATION Owner tc'Qcc 1 ( Company Name J S DA91 �' Mailin ddr Mailing Address .•► City A 0 state (AJR Zip Code City Mate Zip C^,�„+�-r Phone ab- ag Othe Ph -&0 0-0$ IJ Phone n;rh�•pF'" Lien/ itle Holde — Contractor Reg. Exp. E mail a ress OW ��' �� E Mail Address Drivers Lic.# ,-4 DOB l0-ola' q& Drivers Lic.#-'- DOB SEPTIC INFORMATION - Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. — 1-4— q00450 Fire District s� Legal Description rqr Su,i,v'e g Site Address (Plea include street name, street number and city) P D're t' ns�o site l P a. 56' Is property within 200'of altwa r Lake Is Rive /Creek Pond Wetland & Seasonal Runoff Stream6_Slopes or Bluffs > 15% TYPE OF JOB - New Add Alt Repair Other Use of Building Location of Fixtures/Units - 1 st Floor d Floor Basement Garage Closet PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS Type of Fixture No. of Fixtures Fees Fuel Type:Electric_ LPQ-,& Natural Gas Heat Pump_ Toilets Type of Unit No. f Units Fees Bathroom Sink Furnace -- ^ Bath Tubs HeaSpot Vent Ft Showers � Spot Vent Fan Water Heater Propane Tank Clothes Washer G Ou is Kithen Sinks cc; Pellet Stove Dishwasher Kitchen xhaust Hood Hosebibs Otherer Vent G45 Other took 7`ap Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL 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. PROOF OF NTIbIQATION OF WOK Y M NS OF A PROGRESS INSPECTION. G X Date: -7— 0 caner Owners Representatfve/Contractor (indicate which one) FOR OFFICIAL USE BEYONDTHIS POINT Accepted by: Planning Pd Ck# Date Bld Pd Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Occ Group-Type Constr.- Planning Constr.- Planning Department Environmental Health Department FEES Plumbing & Base Fee Site Inspection Mechanical & Base fee UFC Plan Review Fee Wood/Gas/Pellet Stove Fee Other Violation Fee TOTAL FEES INVESTIGATION REPORT FORM t Revised 10/6/94 Part A: Nature of Complaint • Initiator's Name: • Address: • Telephone: • Owner Name: • Address: r / • Telephone: • Department of Concern . ❑ Clerical ❑ Building ❑ Health ❑ Comm Development ❑ Fire • Area of Concern: ❑ Process Delay ❑ Personnel ❑ Policy/Fee ❑ Code Violation ❑ Other Refer to Director • Location of Concern: jPc rs • Nature of Concern: i" t r� Part B: Concern Intake and Referral Received By: Referred To: Response Date: Name Date Name Date Date L Part C: Findings Referral Forwarded to: ❑N/A Name Date Findings: Part D: Resolution / t - �j �k Name Date LIntake Copy-White File Copy-Yellow Referral Copy-Pink Ilk rr 1 • _ A. H �iY�EGSE�+- �1' u.+.F C/�-C)Z CqMs- 1 6d a`� c�gr'-r®��� T/2• lit lee - Z Ll � � 5,61 Y4fKKrL5FX) ED, S �l t LToo VA • 5 ow ?7M 4Z 7- ©Z 41 �L LT ��C r S TQrQCA U- �Civ7�Y ® 5 6 r O 19 i ILL ! �'� S i P-kJ Sys 7 K 94 S e w aC h "g i-D ► mod a� l�v 7> o �� liYl 1zC 2� ss CO b T S T---LP C, Ej,C ?T2 Al* �e oto �7,74:C 7rjes- /4 CtiS TiKczr-> Tz i-�( <z s r C ,vc 2 S r-� v rZ C-- citJS� ��C 7 taco �p�y� (, /Zo 1 Zoo 1 - MASON COUNTY Permit Assistance Center Building Department/Fire Marshal 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 NOTIC IS HEREBY GIVEN THAT THIS BUILDING MUST NOT B PIED UNTIL INSPECTED AND APPROVED FOR OCCUPANCY For Further Information Regarding This Notice, Phone 427= 9670 c D�rzs�t5 DEN Date By 777� Building Inspector/Fire Marshal The Removal, Mutilation, Destruction or WARNINGConcealment of This Notice is Punishable by Law