HomeMy WebLinkAboutMIS99-00234 Cancelled Daycare Requirements Pre-Inspection - MIS Application - 5/11/1999 MIS
MASON COUNTY
�. PRE-INSPECTION APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 •427-9670
4-9 DO Fee Required prior to inspection
PLEASE PRINT
#1 Owner 0-nL Phone#
Site Address q( City -`3bct40y%
Mail Address 41 E, CtiA'b
city 5XkA%z;V\ St lAJA zip CJ
Applicant Phone#
Applicant Address
City St Zip
#2 Parcel No.
Legal Description e_
#3 Purpose of Pre-Inspection Do-,( Cam- M
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#4 Use of building �%QK.
#5 Indicate by circling the applicable source if any water is on or adjacent to subject property:
saltwater ak creek stream marsh river pond wetland seasonal runoff other
Directions to Site: L 0.*- Yy\G•-� LiR.- (�jL \
Show following on the site plan below: Lot Dimensions, Existing Structures, Structure Setbacks, Water Lines, Septic Systems,
Flood Zones, Wells, Shorelines, Easements, Name of Flanking & Fronting Streets. Indicate directional by N, S, E, W, etc.
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Applicant Signature ^ C =0U& Date
FOR OFFICIAL USE ONLY: Accepted by: Date:
Receipt No. Referred To
DEPARTMENTAL REVIEW
FOR OFFICIAL USE ONLY
Proposal Proposal
Approved Denied
Planning:
Building:
Fire Marshal: Z
Special Conditions
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FIRE & LIFE SAFETY INSPECTION: STATEMENT OF DEFICIENCY & CORRECTIVE ACTION
FACILITY 51 cTp/ 1IE � AA 7 r ADDRESS �j' � CITY ; PHf?1�Er_ZG�`_
NAME G j71IV `/ v�/V �1
INSPECTOR AGENCY DATE
DAVE SALZER 360-427-9670 X-273 MASON COUNTY FIRE MARSHAL FD
ITEM STATEMENT OF CODE OR WAC CORRECTIVE ACTION CORRECTION
NO. DEFICIENCY REFERENCE REQUIRED REQUIRED BY
DATE
212
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THE DEFICIENCIES DESCRIBED ABOVE HAVE BEEN SIGNATURE REINSPECTION DATE
EXPLAINED TO ME, AND I AGREE TO MAKE CORRECTIONS 41
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NO LATER THAN THE DATES INDICATED
019
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White Copy: Occupant— Yellow Copy: Fire Marshal — Pink Copy: Fire District