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BLD97-00576 Cancelled Mobile Home - BLD Letters / Memos - 1/13/2000
MASON COUNTY r Mason County Bldg. III 426 W. Cedar pRIIEXpIVIpT10N P.O. Box 186 Shelton, Washington 98584 & Jo@ ,,I �ZBY OAT 0 1 N C P F- R M i T- ["OR INSPECTIONS CALI. 427--9670 BETWEEN 5pm AND Sam 42.7--7262 BL..D97 -0576 PARCEL. t 322027590071 PLAT: D i V :? BLK :? LOT :? ./0B_ ADDRFSS c 288 NE TFE I-AKE RU TAHUYA i { OWNER : 4tL.MOS KEREZ811 CONTRAGTORc I EGAL t 18 &-t OF SP 12377 SEE SQkV 316 " '[YR:.�..'L+':Y'9WNS.�C9-n'162"A.+l:>:"34i'.rr^}-GtTl�@ ..:�T:3•.,, N CLASS OF WORK. . . cNFW PF OR t 3 .BATHS ::" TYPE ANONNT BY DATE RECEIPT TYPF AMOGNT FY DATE NECF! TYPE OF USF . . : . :MIT STORIES . . . . . . . : 1 � �� ': ,.< _: r., OCCUP . GROUP . , *? BU DG . HF I GHT . . c 0 .0f t ADDA 8 5 08 KS 911r 7188 40328 TYPF OF CONST . . c? VI REPLACES . . ,. . : 0 NI(Af 1 155.00 ?..S OtI21041 46328 OCCUP . I. 0AD . . . . : 0 WOODSTOVES . . t¢ STEF 1 4.ti# KS 11127198 46,)28 i DWELL .UNITS . . . c 0 PARKING SPACES t 0 �ENCp 8 26.04 ka 81127198 463:8 c INSPECTION AREA c SHORE I- INF? . . . , tN � �TDIAL! VAIUTATIONt 1..8841 SETBACKS — _...-- . __._. TOILETS . . . . . . . . . . t 0 F'UL L.. TYPES------. ----- - BOILERS/COMP- ----- MOP I LE HOME— FRONT . . .F 90 .0'F t BATH BASINS . . .. . . . t 0 s 0- 3 HP . : 0 REAR . . . .W 50 .Oft BATE! TUBS . 0 3--15 HP . : 0 MODEL O- I BE RTY S I DE M .N 1 50 .Oft SHOWERS . . . . . » . . . . t 0 F URN < 1 00K BTU c 0 1 5- 30 HP . c 0 VIA VF .-. -, -- : SIDE:(2 ) .S 80 .0f t WATFP HEATERS . . t 0 F 1.1RN >=-100K VTU : 0 30--50 HP . t 0 OAKBROOK SHRL I NF . 0 ,0ft CLOTHES .WASHERS . 0 F"L1 N - FLOOR , . . c 0 50+ HP . : 0 YEAR f AREA --- ---- - --- ---- KITCHEN SINKS . . . . 0 IIF11T PUMP' . . . . . . : 0 84 LOT SIZE . . FLOOR URA 1 NS . . . . . 0 V1 N I' SYSTEMS .. . 0 E VAI' COOL FIRS , N 1_ENGTFf c 5 BUILDING . . . : osf DRINKING FOUNT _ : 0 VENT FANS . . . . . . t 0 HOOPS . . . . . . . : 0 WIDTH . :24 BASEMENT . . - t 0sf I.AUNDRY 'TRAYS , 0 DOMES . I NC I N -.0 :+FR I AI 02CKS . . . . . . t Osf L)I SHWASHERS . . . . . . . 0 AIR EIANOL I NG UNITS-- COMML . i NC I N :O 0449 ? � GAR/CARP t? 0t4 GARB DISPOSALS . , . t V <r. 10000 0 f m . : 0 RIc L.Of J RED PA I R : 0 21 AT/DT . :? URINALS . . . . . . . . . . 1 0 > 10000 crm : 0 OTHER UNITS . : 0 Z �' MISC PLM rIXTURFS : fo CAS ULtTLt''FS . s 0 / 5t R4.._-^�;�'G'i'L�:�,.C.—.^Y6:'A"v...Ti'R:lY�7.':V=�:3:.XY"S YiI.'Jl�t;�-�t..'.Z�'.%!'�.6'��'�'.Yi6-:TY�1a9.9i.t:!EOIF'.iIDV.'+LG�'si:.ls:li�y"Z..'..�TI!...:)L.LL.1 '�L:::�i.•PROJECT OESCIIPTIO11.9081LE .HONE g' PROJECT COCATIONcOff OF TEE LAKE RD 111611T bN 46 Tff IAFE PINES (DIR1 90) .SITE .IS ON LEFT �10E AINOSI TO ENT) Of ROAD. THIS,PEINIT BECONES NULL AND VOIQ IF 1094, 01 C IS.T-IlgtlIQN AUTHORIZED IS NOT1411 ENCE6 WITHIN 100 DAI&, OR If CONFTRUCTION 4 MOAk IS SUSPENDED FOR :'kNiOU Of 180 DAYS AT ANY 111E AFTFR IIORK IS CONNENCFB. EVIDENCE OF CONTINUAT1.1 OF !OAK IS A PROGRESS 10PEC1IO4 WITHIN THE 188 DAY PEAIOO FIRM, iNSPEC1 Ti 1111^' BI: k AOFROVfI :BEF01F BUILAIN6 CAN 8F OCCUPILR. E /�} OWNER OR AGENT t DATE:r `l dt1' P4IIT rev. 83131141 Ct)MPI t ANCU TO. A'I TA(;HFD CONDITIONS IS RFOIJ I Pi n r CONCRETE MECHANICAL MOBILE HOME Footings-Setback date by Ribbons date by Gas Piping date b Foundation Walls date by Set Up date by INSULATION date by BG/SLAB Insulation Floors Final date by date by date by FRAMING Walls FIRE DEPT. date by date by date by PLUMBING Attic OTHER Groundwork date b date by D.W.V. WALLBOARD NAILING date by date by Water Line FINAL INSPECTION date by date by date by i i i Building Permit # �� MASON COUNTY BUILDING 111 426 W. CEDAR SHELTON, WASHINGTON 98584 (360) 427-9670 CORRECTION NOTICE Job Location � %',E zui zg'g TE i�o. This structure has been inspected by Mason County Building Department and the following VIOLATION of County Laws and Ordinances has been f0 d: Items Listed below must be corrected to gain code compliance iSs/� rvs��ild r`� l3 Lcal✓ di?G n�f c �-/1 ��Z . 44 �^-sa�.rt-T� zz� Tamil G �G � c� /� — ✓ C O You tifie t e correct�o s 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 o�� �S,�y s ❑ This is not a 6ofnplete inspection Department 'gcz2 Date Inspector ■ so0 No OT Mo *V T 1 , T " ,�� MASON COUNTY Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 PF F1f,,4 1 T' C « N [ l 1 -T 1 C7) Nt Case No . : BLD97 -0576 For , V I LMOS KERFZS 1 Page : 1 1 ) the undersigned property owner is aware of the uncertainty regarding Mason Count . ' . development regulations created by the Growth Managment Hearings Board 's Order o ' ,October 2, 1996, and In consideration of Mason County ' s willingness to proceed with processing of applications which might be affected by the Order , the undersigned FF>1,4t,Wperty owner hereby agrees to waive any lawsuit , action , or olaim for damages againtat Mascri County which may arise out cif Mason County 's actions In acceptance processing anti/or issuance of such permits or approvals ( hereinafter "permitting arilions " ) , which damages are attributable to the County 's decision to take permitting actions despite the risk that changes to the County 's development regulations Wight later, make the Count permitting actions invalid . X - 2 ) Ihis appl icat ion is subject to Buffer and Landscaping requirements as estmbl ished iirider Mayon County Ordinance 1 .03 .036 . X 31 The use, handling and storage of hazardous materials or flammable and combustible liquids In excess of 10 cia F i oriv 1 �j not allowed without the approval of the Mason Count v Fire Marshal . X 4 ) Proposed structure or any portion thereof greater than 30" in height Prom grade line , must maintain a minimcim of 5 ' setback from all property lines , easements and 10 ' from all o my and State Read right of ways . X 5 ) Approved p,.!r d imen,, ions, and set baok�i on ,ubm i t tet! s i to plan . X._._-_� 6 ) PURSUANT TO 1994 UNIFORM BUILDING CODE SECTION 305(C ) AND SECTION 513 , ALL SITES MUST HAVE APPROVED NUMBERS OR ADDRESSES PR6VIDED IN SUCH A POS1IION AS TO BE PLAINLY VI 1BL.E AND LEGIBLE FROM THB STREET OR ROAD FRONTING THE PROPERTY . MASON COUNTY BUILDING DEPARTMENT RUQU1RES THAT THIS BE COMPLETED PRIOR TO CALLING FOR ANY SITE INSPECTIONS . A RE I NSPFCT 1 ON FEE , BASED ON RATES ' I N TABLE 3A OF THE 1994 UNIFORM Bt1 I L.D I NG CODE WILL BF MASON COUNTY Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 ASSESSED IF OWNER/CONTRACTOR FAILS TO POST AVORESS ON SITE PRIOR TO RFQUESIING INSPECTIONS . 7 ) REOU I RED INSPECTIONS ( Foot i nq Ins i on�-prior to pour , 'Set - up Inspection-prior to skirting, Final inspection-pricar to occupancy ) . I have received a co Hy of the General I rrf ormat 1 on -.and C,u i de I i nos-Mob i l e/Manufcic.Jured Hour; i nq I nsta I I at I cans andout for, detailed descriptions of all required inspections on my mobile/manufactured home installation . I her ebb assume all responsibility for the scheduling of these required Inspections . If tl�ese required Inspections are not requested . Inspected and signed off (approved) by the Inspector in the proscribed under , 1 undeyre,tand that its i iispect i un fees and an hourly invests ation fee pursuant t the 1991 UBC, Table 3A will be assessed in addition to my car i g i na? permit fees to resolve any q+iest i onab i e practices or, prob l erns that have been discovered . I further, understand that this I ravest i qat i on will be scheduled as time allows . Unt i I reso i ut i on of ariy/a 1 1 problems no ooc;upanr..v ( Final I nspeot ion ) wI I I be granted for the res idenc;e . '7- OWNER/CON'I'PACTOR ( indicate which) Signature X �- t_ �•_.__.�__._.__._.._��_.. 8 ) A I I mobile/manufactured home landings or decks must be freestanding ( self supporting ) , The i arges t I anal i nq or neck perm r tte>d without draw i n s or :a bu l i d i ng permit I s 36" x 36" . Anv landing or deck that Is 30" or more it) he i g t from walking surface to f i n i .rh r ade requires a jueardra i I . Any landing or deck that• has 4 or more risers requires a andrall . Any landing or deck larger than 36" x 36" must be permitted which requires straioturai drawings and a taus lding permit application . This ins tal latiun Permit does NOT include any landing or deck larger than the 36" x 36" r i ze . 232.45 1 73.46 a ti0 G 2 !. 31 AC. G 3 3 ti 1. 63 AC. i9 s?• 100 1 R. � Z ? �'S• PROPOSED PROPOSED •� ie 4` loot 130+E Ab �5°37 N 890 58'56' E 223. 87 -& PROPOSED 31 130 d!COJ � V 100' R. �58l oo t R. \4� ® PROPOSED _ / � N 0 50 FT. RADIUS ap 3 - QQ h� / �l0 ^ ?64' 9q N TS°5g�/6' 1. 23 AC. 2377 E 4 ® 234 08 .01 O / 1. 37 AC. .`L <; 2 / 1.27 AC. \a E L 2 �l ?3q \V�' •\h l0 PROPOSED 1 . 21 AC. ` 1. 21 AC. . .34. 08 /►Y � . � 100' R. h � 2/• 9/ � h 00' R. Z2/. 9/ �0 1.21 AC. 100 00 t PROPOSED R. PROPOSED % h / ti /• �tp loot R. %\h D 14v91 h t—x- 1. 38 AC. 4j / ® PROPOSED �\ loot R. 9/JO C\ .to . 87 D 2 ti; ti6ti � 1. 21 AC. ti D H TS°59116 0 . 05 1.21 A C. LEGEND 2p9.OS D 4 _ 867. 0 z � 1.21 AC. .\h - 5/8' REBAR WIPLAST r C CAP SET AQQAC 0, 1zti LS NO. 28237 09. 05 ,►�� O • FTD. 5/8' REBAR M/PLAST I C CAP LS NO. 11355 ® SOIL L00 S� toot R• ? / ?S• PROPOSED A� 0'4 PROPOSED R. V 1 ti G 1 . 27 � 234. 08 E 2 V 1 . 21 AC. 08 _ I-ROPOSED � 1 . 21 AC. 100 ' R hj � O PROPOSED l oo l R. �� r - File Edit Optiorjs Vfindow Help --....... ............... H 0 gfl 1 fS?l $ I �,-r 1 97-00576 S tatus CAN ❑ X [-77--,, , Name: VILMOS KEREZSI Updated: 1'13/00 KW Address: 201 NE TEE LAKE PINES TAHUYA Descri_�tion: 1`,laster ## SWG94-U1943 Project: EE LAKE PINES Constr.:_ f r,cc. t,lC,BILE Hilt-,1E Area� Mobile Directions to Site: Plumbing OFF OF TEE LAKE RD RIGHT ON ON TEE LAKE PINES (DIRT RD) SITE IS ON LEFT SIDE Type of Use: Hnrn Mechanical ALMOST TO END OF ROAD. Type of Work: PJe%:v Shoreline 8 rethack�: Inspection Area: Finaled: F_ Issued- Fire District: Expiration: 10L?10 `I Received: 722 7 To7�� Total 'Valuation: Printing r 3:_e '.Summary Beport for BLD97-00576 Skart 14. 6 PERM ITIPLAN td,:).-ell-deliveredApplicatio... ° v ordPerfect oil yright O 1997-1999 Tidemark Computer Systems Inc. 7 /01 All Rights ad. A 7/19/01 Information Summary for Case #: BLD97-00576 5:52:35 PM Activity Hold Updated Activity Description Date 1 Date 2 Date 3 Disp. Level By Updated BLDA010 Application received 5/22/97 KW 5/22/97 BLDA015 Waiver in File 7/1/97 DONE NJP 7/1/97 BLDB134 RLC Review 6/11/97 N/A AHB 6111/97 BLDB110 Structural Plan Review 6/11/97 6/16/97 DONE TLG 6/16/97 BLDB130 Planning Review 5/28/97 6/11197 DONE AHB 6/11/97 BLDB135 Addressing 5/23/97 5/27/97 DONE GMM 5/27/97 BLDB138 Planning Pre-Review 5/27/97 5/28/97 DONE MMS 5/28/97 BLDB200 Environmental Health Review 5/22/97 5/23/97 HOLD CAJ 5/23/97 need approved design BLDB210 Water Adequacy 5/23/97 5/23/97 HOLD CAJ 5/23/97 Tee Lake Pines...need water adequacy form completed BLDB200 Environmental Health Review 6/16/97 6/18/97 HOLD CAJ 6/18/97 still need approved design BLDB210 Water Adequacy 6/18/97 6/18/97 HOLD PSD 7/2/97 still need water adequacy form completed PUT IN PAMS BOX TO REVIEW.7-1-97 7/2/97 The Tee Lkae#2 water system needs a SMA in order to be completely approved.psd BLDB200 Environmental Health Review 12/4/97 12/4/97 DONE PSD 12/4/97 The design was approved on 11/20/97.The plot plans and bedrooms match.psd BLDB210 Water Adequacy 1214/97 12/4/97 HOLD PSD 12/4/97 The Tee lake Pines#2 water system is adeqaute, BUT there is no water adequacy application in the file. Need application signed by the manager. psd BLDB210 Water Adequacy 1/27/98 1/27/98 DONE PSD 1/27/98 The water adeqaucy application was signed by the managre was submitted.psd BLDA100 Approved For Issuance 1/27/98 DONE KS 1/27/98 BLDA500 (F)Issue building permit 1/27/98 DONE KS 1/27/98 BLDA560 Permit cancelled 1/13/00 DONE KW 1/13/00 BLDC200 Mobile Home Set Up 4/5/00 // 4/5/00 FAIL No Hold TLG 5/7/01 1. Post addres install missi tie down replace missing insulation,#_repair belly wraph x 16 bloc to be placed on level firm native soil b ow organic Complete arriage line trim 7. Insulate water line w/closed culation II drain lines to be ABS or PVC w 1/4"per ft fall 9. Inst I gate valve below belly material on water supply 10. Remove all material stored under unit BLDC200 Mobile Home Set Up 4/19/01 4/20/01 FAIL No Hold TLG 5/7/01 1. Clean out cap at Y 2. Install dbl Y on sewer 3.Support dwv 4"OC 4.Complete installation of vapor barrier and repair. Temp occ for 90 days. 7/19/01 Information Summary for Case #: BLD97-00576 5:52:35 PM Condition Cond. Stat. Changed Updated Code Title Hold Status Changed By Tag Updated By 0005 DISCLAIMER/WAIVER OF LIABILITY Not Met 5/28/97 MMS The undersigned property owner is aware of the uncertainty regarding Mason County's development regulations created by the Growth Managment Hearings Board's Order of October 2, 1996,and in consideration of Mason County's willingness to proceed with processing of applications which might be affected by the Order,the undersigned property owner hereby agrees to waive any lawsuit,action, or claim for damages against Mason County which may arise out of Mason County's actions in acceptance,processing and/or issuance of such permits or approvals (hereinafter"permitting actions"),which damages are attributable to the County's decision to take permitting actions despite the risk that changes to the County's development regulations might later make the County's permitting actions invalid.X 0046 Buffer+Landscaping Requirements Not Met 5/28/97 MMS This application is subject to Buffer and Landscaping requirements as established under Mason County Ordinance 1.03.036.X 5001 Flammable+Combustible Liquids Not Met 5/28/97 MMS The use, handling and storage of hazardous materials or flammable and combustible liquids in excess of 10 gallons is not allowed without the approval of the Mason County Fire Marshal.X 5025 Sideyard Setback Not Met 5/28/97 MMS Proposed structure or any portion thereof greater than 30"in height from grade line, must maintain a minimum of 5' setback from all property lines,easements and 10'from all County and State Road right of ways. X 0200 Site Plan Not Met 6/11/97 AHB Approved per dimensions and setbacks on submitted site plan.X 1002 POST ADDRESS Not Met 6/16/97 TLG PURSUANT TO 1994 UNIFORM BUILDING CODE,SECTION 305(C)AND SECTION 513,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 IN TABLE 3A OF THE 1994 UNIFORM BUILDING CODE WILL BE ASSESSED IF OWNER/CONTRACTOR FAILS TO POST ADDRESS ON SITE PRIOR TO REQUESTING INSPECTIONS.X 5007 MOBILE/MANUFACTURED SPECS. Not Met 6/16/97 TLG REQUIRED INSPECTIONS(Footing Inspection-prior to pour, Set-up Inspection-prior to skirting, Final Inspection-prior to occupancy). I have received a copy of the General Information and Guidelines-Mobile/Manufactured Housing Installations Handout for detailed descriptions of all required inspections on my mobile/manufactured home installation. I hereby assume all responsibility for the scheduling of these required inspections. If these required inspections are not requested, inspected and signed off(approved)by the inspector in the prescribed order, I understand that reinspection fees and an hourly investigation fee pursuant to the 1991 UBC,Table 3A will be assessed in addition to my original permit fees to resolve any questionable practices or problems that have been discovered. I further understand that this investigation will be scheduled as time allows. Until resolution of any/all problems no occupancy(Final Inspection)will be granted for the residence.OWN ER/CONTRACTOR(ind icate which) Signature X 5013 Mobile/Manufactured Landings/Deck Not Met 6/16/97 TLG All mobile/manufactured home landings or decks must be freestanding(self supporting). The largest landing or deck permitted without drawings or a building permit is 36"x 36".Any landing or deck that is 30"or more in height from walking surface to finish grade requires a guardrail. Any landing or deck that has 4 or more risers requires a handrail. Any landing or deck larger than 36"x 36"must be permitted which requires structural drawings and a building permit application. This Installation Permit does NOT include any landing or deck larger than the 36"x 36"size. X Fees Fee Trans. Create Created Type Description Code Revenue Account No. Date By Amt.Due � ADDR Address Fee 369.00 KS $5.00 MHOF Mobile home fee.... 322.10 KS $155.00 STFE Building State Fee 386.00.05 KS $4.50 I EHCP EH Plan Review ? KS $26.00 INSP Site Inspection 342.40 5/7/01 TLG $47.00 REIN Re-Inspection 342.40 7/19/01 JRN $47.00 II Case People Listing Role Type Name/Address Company Name Hold Primary APL VILMOS KEREZSI Y NE 980-301 SHOE LAKE ROAD TAHUYA WA 98588 I III File Edit Options `,-Vindoo) Help rrr IN Building PeFmit --BLD97-00576 Status CAN ❑ X Name: VILMOS KEREZSI Update& 1/13/00 KW General Address: 201 NE TEE LAKE PINES TAHUYA Description Master #JSWG94-01943 � Project ffEE LAKE PINES t-v1OBILE Hi=1t,+1E Area a Mobile Construction Information Occupancy Information Plumbinq No. of Bedrooms: t Type of Construction. Mechanical No. of Bathrooms: r Occupancy Croup: No. of Stories: 11 _ Occupancy Load: Shoreline , setbacksBuilding Height: Occupancy Status: F III P H77 Case ummary Report for BLD97-0u576 $tart xaHERMIT'P N t i ;•;'eyed li�al ; ':'ordF'ertect LA RP , Copyright©1997-1999 Tidemark Computer Systems Inc. 7/19101 All Rights Reserved. L PERMIT'PLAN File Edit Options 1,Vindow Help ....................... ad H I Fa I "ni M1 a I i--- 1r;EF ICI .01 1 ct Is I vv:y.)I w Iwo W B udding Peffmit --8 LD 97-00576 S tatus CAN NMI M flame: VILMOS KEREZSI Updated: 1/13/00 KW General Address: 201 NE TEE LAKE PINES TAHUYA Description: Master#ISWG94-01943 Project: [FEE LAKE PINES Constr. Occ. P,,-ICIBILE HOME Area Information Mobile Home Info PIUMbing Lot Size: SF Make: ILIBEPTY Mechanical Building: SF Nlodel: 10.4�.1K.BPOOl< Basement: SF Year: =4 Shoreline,I& Deck: SF Length: F5 2 Ga ra g e/C arp ort: SF Widthl- Other: SF Serial Number: )--1449:--;26 P"rtnTn=�rwe'Sbririih6(Y'R rt If or B LD 9-e-00576 ......... J StartPERMWPLAN N ovell-delivered Ap effect Copyright @ 1997-1999 Tidemark Computer Systems Inc 7/19/01 All Rights Reserved. L File Edit Options Window Help 1 I I 1 111 !!! ❑ x Name: VILMOS KEREZSI Updated: 1I13!00 KW General Address: 201 NE TEE LAKE PINES TAHUYA _l "n • Description: (blaster# SWG94-01943 Project: Y EE LAKE PINES _t r. [`C h;-11-113ILE HOME .area d Mobile Plumbing Fixture Type (quantity Notes Mechanical Shoreline t Setbacks 1 ► Vow lrtning .rase urnrriary Report for BLD97-00576 ; Skart aPERMIT'PLAN Novell-deliueredApplicatio...� 'wrordPPrfPrt Copyright©1997-1999 Tidemark Computer Systems Inc. 7/19/01 All Rights Reserved. L File Edit Options 'Windoav Help qL EEE 1 II ❑ X Name: VILMOS KEREZSI Updated: 1/13/00 KW General Address: 201 NE TEE LAKE PINES TAHUYA Description: tylaster # SWG94-01943 Project: [FEE LAKE PINES uonstr. f Occ } Fd10BILE HQP,,1E Are;3� Mobile R rtbing Mechanical Fixture Type Quantity � Notes Shoreline& Setbacks 4 JAW ► F'tir-161-Ig Ca>;e ',I_rrnrnary Report for BLD9i 005 ;Start x�APERMIT�`PLAN i�oa'elldeli�eredApplicakio...� ,end Copyright©1997-1999 Tidemark Computer Systems Inc. 7119/01 All Rights Reserved. i File Edit Options WindotA/ Help jpl+Ito 1 &21 -nlM1 .. . { EEC� Building Peffmit BLD97-00576 Status CAN Name: VILMOS KEREZSI Updated: 1/13100 KW General Address: 201 NE TEE LAKE PINES TAHUYA Description: Master # SWG94-0 a 1943 Prcject: EE LAKE PINES Sonr.% P Occ. P;+10BILE HI.-It-dE Area Mobile Pltunt7incg Setback Dir. Feet Shoreline and Planning Info Front: E - {0 Shoreline Desiq.: Mechanical Pear: ;` J r0 eater Bnd_; Side 1: 'Pd SEPA l'-] rShoreline Slue 2: 11 � Comp. Plan Desna.: Shoreline Setback: F.__,_.--_ Slope Setback: — Ithw . aseT IMM-4 Re crt for 8 L D 9 7-0 0 5 7 6 JA— Skart ,"PERMIT'PLAN Novell-deliveredApplicakio. � V ordPerfect I ' Copyright©1997-1999 Tidemark Computer Systems Inc. 7/19/01 All Rights Reserved. Permit No. MASON COUNTY BUILDING PERMIT APPLICATION 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 PLEASE PRINT #1 wner V j1 "C.S W.F9 E-Z� / Phone# 360 / 32 —-2 ao-le-7 q ite A7&hVU6L- ss K OGc Fire District# citySt WG- Zip 6588 Directions to Site [OFF OF TE6 LK. RD - RiG!?f nn n, e e 4-ake-, P,` e i-r t a o rOeLa Owner Mailing Address FVL O Lk. City Tl 1) +1 U V�9 St U, 19 Zip Lien/Title Holder Address Clty St Zip #2 Contractor Name Contractor Reg# Address Expiration Date City St Zip Phone# #3 If septic is located on project site, include records. Connect to Septic? Public Water Supply Well rl-� • Ak� Connect to Sewer System? Name of System (If residential, proof of potable water is required) #4 Parcel No. �O�- - q00V/ 0Legal Description T R C- I OF 5 P ?et 2-37 SF .S U R V 3/6 #5 Building Square Footage: (existing/proposed) 1st FI / 2nd FI / 3rd FI / Loft / Basement / Deck / #bedrooms / #bathrooms / Garage / Carport / (Circle:Attached or Detached?) Other sq. ft. / #6 Use of building Describe work #7 Type of Job: New Add Alt Repair Other #8 BILE/MANUFACTURED HOME INFORMATION O Aodel Year / Make L Model Oa*-brook Length ba Width a Serial No. O�LI g3o2 �p #Bedrooms 1,-3 # Bathrooms_��Type of Heat 8:18 Purchase Price$ /s� 6-o-� #9 Indicate by circling the applicable source if any water is on or adjacent to subject property: River Pond Creek Stream Wetland Lake Marsh Saltwater Seasonal Runoff Other r Show following on the site plan Lot Dimensions Flood Zones Existing Structures Fences Structure Setbacks Driveways Water Lines Shorelines Drainage Plan Topography Septic Systems Wells Proposed Improvements Easements Name of Flanking Street Indicate Directional by (N, S, E, W) Name of Fronting Street in relation to plot plan APPLICANT TO DRAW SITE PLAN BELOW APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW Plumbing Fixtures ($3.35 each) Fee Mechanical Fixtures ($6.75 eachl ._Toilets CIRCLE FUEL TYPE: Gas, Electric, Bath Basins Heat p, Other th Tubs No. nits Fees Sho ers Furn BTU Hot Wa r Htr _ Heatpumps _Laundry sher _ Vent Systems _Sinks _ Spot Vent Fans Floor Drains No. Boilers/Compressors _Laundry Basins _ HP Dishwasher No. Air Handling Units _Disposal _ cfm# _Urinals No. Fire Protection Systems _Other _ Auto. Fire Alarm Sys 50.00 Fixed Fire Supp. Sys 50.00 Permit Basic Fee 16.75 _ Auto Fire Sprink Sys 35.00 TOTAL PLUMBING $ No. Other Gas Outlets Wood, Gas, Pellet Stove NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COM- MENCED WITHIN 180 DAYS OR IF CONSTRUCTION OR Permit Basic Fee 16.75 WORK IS SUSPENDED OR ABANDONED FOR A PERIOD TOTAL MECHANICAL $ OF 180 DAYS AT ANY TIME AFTER WORK IS COM- MENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT CERTIFY THAT I AM EXEMPT FROM THE REQUIRE- I CERTIFY THAT I AM A CURRENTLY REGISTERED MENTS OF THE CONTRACTORS REGISTRATION LAW CONTRACTOR IN THE STATE OF WASHINGTON AND RCW 18.27, AND AM AWARE OF THE MASON COUNTY AM AWARE OFTHE ORDINANCE REQUIREMENTS REGU- ORDINANCE REQUIREMENTS FOR WHICH THIS PER- LATING THE WORK FOR WHICH THE PERMIT IS ISSUED MIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN AND ALL WORK DONE WILL BE IN CONFORMANCE CONFORMANCE THEREWITH. NO CHANGES SHALL BE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT MADE WITHOUT FIRST OBTAINING APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING THE BUILDING DEPARTMENT. DEPARTMENT. X OWNER Tt�/lC6 4_eqL�L� X BY DATE DATE FOR OFFICIAL USE ONLY: Accepted by: Date: DEPARTMENTAL REVIEW FOR OFFICE USE ONLY Approved Cond. Hold Approval Planning: Environmental Health: � •Z� . Building Plan Review Occupancy Group: Type of Const: Fire Marshal: Other: Special Conditions: FEES Building Permit Plan Check Plumbing Fee Mechanical Fee Wood/Gas/Pellet Stove Radon Monitor Violation Fee Site Inspection Building State Fee 4. SO Other a4ctdrQ�`� 5 Other �2 Building Valuation: TOTAL FEE Ig �� MASON COUNTY PERMIT ASSISTANCE CENTER Mason County Bldg.III 426 W.Cedar P.O.Box 186 Shelton,WA 985M (360) 427-9670 Belfair (360) 275-4467 Elma (360) 482-5269 Seattle (206) 464-6968 NOTICE AND ORDER FOR DISCONNECTION OF UTILITIES Date : March 8 , 2000 Owner: Vilmos & Terezaa Kerersi Occupant : Same Utility Provider: PUD #3 Site : 288 NE Tee Lake Rd. , Tahuya, WA Parcel : 32202-75-90071 Legal Description : Tr G-1 of SP #2377 The Mason County Building Department, a division of the Mason County Permit Assistance Center, pursuant to authority granted under the Uniform Code for the Abatment of Dangerous Buildings and applicable adopted codes, does hereby order the disconnection of all utility services to the above site effective March 31, 2000 . The mobile/manufactured structure has not received occupancy approval and information received by this office indicates the unit is in violation of the Mason County Ordinance 45-99 and adopted code regulations regarding occupancy approval . The owner (s) as listed above, have been notified of this violation and has failed to bring the site into compliance as required. Proof of receipt is on file . It shall be unlawful for any person, firm or corporation to erect, construct, enlarge, alter, repair, move, improve, remove, convert or demolish, equip, use occupy or maintain any building or structure or cause or permit the same to be done in violation of the Uniform Code for the Abatement of Dangerous Buildings . Furthermore, Section 701 states : Any such person who fails to comp ith any such order is guilty of a misdemeanor T i r' y Building Inffpect r/Code Enforcement CC : Property File Michael Clift , Deputy Prosecuting Attorney PUD#3 MASON COUNTY PERMIT ASSISTANCE CENTER Mason County Bldg.III 426 W.Cedar P.O.Box 186 Shelton,WA 98W (360) 427-9670 Belfair (360) 275-4467 Elma (360) 482-5269 Seattle (206) 464-6968 March 13 , 2000 Vilmos and Terezaa Kerersi 980 NE Shoe Lake Rd #301 Tahuya, WA 98588 RE : Notice and Order for Disconnection Of Utilities Site Address : 288 NE Tee Lake Rd. , Tahuya, WA Dear Mr . and Mrs . Kerersi , On February 3 , 2000 , I sent notification to you which required compliance action on your part . You received this notice on February 9 , 2000 . Proof of receipt and copy of letter attached . Failure to comply as requested has resulted in the determination that the structure needs to be posted for non- occupancy and the utilities disconnected. I have enclosed a copy of the Notice and Order for DisconnecCion with an effective date of March 31 , 2000 . If you intend to remain at the site legally without interruption of your electric service, you will need to renew your building permit and arrange for a setup and temporary occupancy inspection PRIOR TO MARCH 21, 2000 . If you should have any questions regarding this notice, the prior notice, or the course of enforcement action that Mason County is now pursuing for non-compliance to the previous request , please feel free to contact me at (360) 427-9670 ext 356 . Sin r ly, m1 G f Buildi g Inspector/Code Enforcement CC : Property File Mason County PUD #3 , Karen Burns Mike Clift , Mason County Prosecutor' s office Betty Wing, PAC Director Occupant , 288 NE Tee Lake Rd. , Tahuya, WA • MASON COUNTY PERMIT ASSISTANCE CENTER Mason County Bldg. III 426 W.Cedar P.O.Box 186 Shelton,WA 985M (360) 427-9670 Belfair (360) 275-4467 Elma (360) 482-5269 Seattle (206) 464-6968 April 10 , 2000 Vilmos Kerersi 980-301 NE Shoe Lake Rd Tahuya, WA 98588 RE : Building ildin Permit BLD9 7-0576 Temporary Occupancy Dear Mr. Kerersi, On 4-5-00, our office performed a set up inspection on the manufactured home located at 288 NE Tee Lake Rd. That inspection resulted in the granting of a temporary occupancy for a period of 45 days . That approval will expire on May 22 , 2000 . As of our last discussion, you were in the process of purchasing a replacement unit for this site . In order to allow continued occupancy -of the existing unit beyond May 22 , 2000 , I will require one of the following: All corrections completed that were recorded on the Correction Notice of 4/5/00 and a reinspection performed prior to May 22, 2000 verifying compliance or; The new building permit submitted for the replacement unit by May 22 , 2000 . In the event that you choose to submit the new permit request, I will grant a "progress extension" on the enforcement case which will allow you an additional 30 days to have the new home delivered and set up as required. Enclosed is a permit packet for new submittals and also a photo copy of the correction notice left on site . I will expect to either hear from you requesting a reinspection for the corrections or informing me that you have submitted the new permit application by May 22, 2000'. Si r y, mi Gr Building I spector/Code Enforcement CC : Property File Dana Herron, Building Official MASON COUNTY PERMIT ASSISTANCE CENTER Mason County Bldg. III 426 W.Cedar P.O.Box 186 Shelton,WA 985EA (360) 427-9670 Belfair (360) 275-4467 Elma (360) 482-5269 Seattle (206) 464-6968 March 13 , 2000 vilmos and Terezaa Kerersi 980 NE Shoe Lake Rd #301 Tahuya, WA 98588 RE : Notice and Order for Disconnection Of Utilities Site Address : 288 NE Tee Lake Rd. , Tahuya, WA Dear Mr. and Mrs . Kerersi, On February 3 , 2000, I sent notification to you which required compliance action on your part . You received this notice on February 9, 2000 . Proof of receipt and copy of letter attached. Failure to comply as requested has resulted in the determination that the structure needs to be posted for non- occupancy and the utilities disconnected. I have enclosed a copy of the Notice and Order for Disconnection with an effective date of March 31, 2000 . If you intend to remain at the site legally without interruption of your electric service, you will need to renew your building permit and arrange for a setup and temporary occupancy inspection. PRIOR TO MARCH 21, 2000 . If you should have any questions regarding this notice, the prior notice, or the course of enforcement action that Mason County is now pursuing for non-compliance to the previous request, please feel free to contact me at (360) 427-9670 ext 356 . ASinr ector/Code Enforcement Cc : Property File Mason County PUD #3 , Karen Burns Mike Clift, Mason County Prosecutor' s office Betty Wing, PAC Director Occupant, 288 NE Tee Lake Rd. , Tahuya, WA GARY YANDO,DIRECPO; �pN STA M U �, DEPARTMENT OF COMMUNITY DEVELOPMENT o T Z PLANNING - SOLID WASTE -UTILITIES '> N Y Y BLDG. I • 411 N. 51"ST. 0 P.O. BOX 578 �0 SHELTON, WA 98584 • (360) 427-9670 1864 DISCLAIMER/WAIVER OF COUNTY LIABILITY: PERMITS ON EXISTING LEGAL LOTS OF RECORD, LAND DIVISION APPROVALS, SHORELINE PERMITS, VARIANCES, AND SPECIAL USE PERMITS: The undersigned property owner is aware of the uncertainty regarding Mason County's development regulations created by the Growth Management Hearings Board's Order of September 6, 1996, and in consideration of Mason County's willingness to proceed with processing of applications which might be affected by that Order, the undersigned property owner hereby agrees to waive any lawsuit, action, or claim for damages against Mason County which may arise out of Mason County's actions in acceptance, processing and/or issuance of such permits or approvals (hereinafter"permitting actions"),which damages are attributable to the County's decision to take permitting actions despite the risk that changes to the County's development regulations might later make the County's permitting actions invalid. Date (Parcel No. or Legal Descrip(ion) Property o r s signature(Notarized) (or the County may accept the signature of the owner's authorized agent upon proper proof of authorization) ACKNOWLEDGEMENT CERTIFICATE (INDIVIDUAL) STATE OF COUNTY OF On this _day of , in the year , before me Notary Public, personally appeared personally known to me to be the person whose name is subscribed to this instrument, and acknowledged that he/she executed it. WITNESS my hand and official seal. -For County use only - Reviewed by applicant on (Date) Notary's signature Staff Initial: My Commission Expires: GARY YANDO,DIREM STA A o DEPARTMENT OF CO DEVELOPMENT o N z PLANNING -SOLID WASTE - UTILITIES N Y ° BLDG. I • 411 N. 5" ST. * P.O. BOX 578 of �o SHELTON,WA 98584 • (360) 427-9670 1864 DISCLAIMER/WAIVER OF COUNTY LIABILITY: PERMITS ON EXISTING LEGAL LOTS OF RECORD, LAND DIVISION APPROVALS, SHORELINE PERMITS, VARIANCES, AND SPECIAL USE PERMITS: The undersigned property owner is aware of the uncertainty regarding Mason County',,development regulations created by the Growth Management Hearings Board's Order of September 6, 1996, and in consideration of Mason County's willingness to proceed with processing of applications which might be affected by that Order, the undersigned property owner hereby agrees to waive any lawsuit, action, or claim for damages against Mason County which may arise out of Mason County's actions in acceptance, processing and/or issuance of such permits or approvals (hereinafter"permitting actions"), which damages are attributable to the County's decision to take permitting actions despite the risk that changes to the County's development regulations might later make the County's permitting actions invalid. 5 - �-2. — C�-1 3 Zaa 75 Coo l l Date (Parcel No. or Legal Description) l-Lu Property owner's signature(Notarized) (or the County may accept the signature of the owner's authorized agent upon proper proof of authorization) ACKNOWLEDGEMENT CERTIFICATE (INDIVIDUAL) STATE OF y/ COUNTY OF L On this�day of , in the year ,before mom _o `>`t l;��� �ftP�i, Notary Public, Ju personally appeared personally known to me to be the person whose name is subscribed to this instrument, and ac owledged that he/she executed it. WITNESS my hand and official seal. �� ��;�ss:onF+q:�Q� -For County use only - TA *? Reviewed by applicant oil '.•,�� C (Date) No 's i • f 1;1� StafT'Initial: _ My 'ssio xpires: �/ ;; SENDER: I also wish to receive the ■Complete items 1 and/or 2 for additional services. follow in services for an y ■Complete items 3,4a,and 4b. g ■Print your name and address on the reverse of this form so that we can return this extra fee): card to you. as > ■Attach this form to the front of the mailpiece,or on the back if space does not 1.❑ Addressee's Address ■Write�t"Return Receipt Requested"on the mailpiece below the article number. 2.❑ Restricted Delivery N N ■The Return Receipt will show to whom the article was delivered and the date delivered. I Consult postmaster for fee. o 0 3.Article Addressed to: 4a.Article Number v _ _7 CC ! VILMOS & TEREZZA KEREZSI o 4b.Service Type Eo 980 NE SHOE LAKE RD #301 ❑ Registered Certified ¢ TAHUYA WA 98588 ❑ Express Mail ❑ Insured c ❑ Return Receipt for Merchandise ❑ COD U 32202 75 90071 7. Date of Delivery .2 3-iS 0 o 5.Received By: (Print Name) 8.Addressee's Address(Only if requested Y V/ /!7 Cl S £0-5/ and fee is paid) t 6.Signature: (Adore see or Agent) ~ '' X H PS Form 3811,December 1994 102595-98-8-0229 Domestic Return Receipt UNITED STATES POSTAL SERVICE - First-Class Mail ►H�1(L_ •Print your name, Mddreps;' nd ZIP Code-in-"s box*--- I i TAMI GRIFFEY I` MASON COUNTY PERMIT CENTER P O BOX 186 WA �n ' SHELTON WA 98584 � y MASON COUNTY PERMIT ASSISTANCE CENTER Mason County Bldg.111 426 W.Cedar P.O.Box 186 Shelton,WA 98-=M (360) 427-9670 Belfair (360) 275-4467 Elma (360) 482-5269 Seattle (206) 464-6968 February 3 , 2000 Vilmos and Terezaa Kerersi 980 NE Shoe Lake Rd #301 Tahuya, WA 98588 RE : Violation of Mason County Ordinance 45-99 Site Address : 288 NE Tee Lake Rd. , Tahuya Dear Mr. and Mrs . Kerersi, On January 27, 1998, our office issued the enclosed building permit (copy) for the placement of a manufactured home . It has come to our attention that the home was placed without the required inspections and the unit is now occupied without occupancy approval . The building permit is now expired. Mason County has adopted through ordinance 45-99, penalties and violations sections with regard to failure to obtain occupancy approval . The Uniform Building Code also prohibits occupancy without approval . This issue has come up because of an allegation that you are now providing electricity by an extension cord to a unit located at 292 NE Tee Lake Rd. , Tahuya. In a review of your file in regard to the complaint, I have discovered the discrepancies with your parcel . The unit at 292 NE Tee Lake Rd. , was recently posted for non-occupancy due to similiar circumstances and the utilities were disconnected for failure to comply with regulations . As I said, a complaint has been received regarding your parcel but not yet validated by a site inspection. I will be conducting a site investigation shortly. If I find the complaint to be valid, I have the authorization under the codes adopted by Mason County to order immediate disconnect to any source that I determine is providing power supply to one which I have previously ordered disconnected. Simply, if I find that you are providing power supply to 292 NE Tee Lake Rd. , I can and will order Mason County PUD#3 to immediately disconnect your power. To bring your site into compliance with Mason County regulations you must : 1 . Renew your expired building permit BLD97-0576 which was issued on January 27, 1998 WITHIN 15 DAYS OF THE RECEIPT DATE OF THIS LETTER. 2 . Obtain required inspections, including occupancy approval WITHIN 15 DAYS OF THE RECEIPT DATE OF THIS LETTER. . 3 . In the event that you are providing power to 292 NE Tee Lake Rd. , immediately discontinue such activity. Enclosed is a copy of Mason County Ordinance 45-99 with sections highlighted that pertain to your circumstances . Please take the time to review these regulations . If you should have any questions about this notification, please contact me at (360) 427-9670 ext 356 . I will be conducting a site investigation and subsequent file review to verify you have complied as requested within the timeline as allowed. SinceyfelY, fmi/GYr & Building Inspector/Code Enforcement CC : Property File Mike Clift, Deputy Prosecuting Attorney Dana Herron, Building Official Mike Barth, Plans Examiner PIJD#3 , Karen Burns enc : Mason County Ordinance 45-99 BLD97-0576 acknowledgement copy Pursuant to Mason County Ordinance 45-99, the following sections apply to the site at 292 NE Tee Lake Rd. , Tahuya: 14 . 20 . 020 General Installation Requirements for Manufactured Homes (B) Installation shall meet all Mason County departmental approvals and conditions required for installation permits 14 . 20 . 80 Inspection of Manufactured Homes : (C3) Final Inspection is required 14 . 12 . 050 Occupancy Violations : Whenever any building or structure or equipment therein regulated by this code is being used contrary to the provisions of this code, the building official may order such use discontinued and the structure, or portion thereof, vacated by notice served on any person causing such use to be continued. Such person shall discontinue the use within the time prescribed by the building official after receipt of such notice to make the structure, or portion thereof, comply with the requirements of the code . It shall be a misdemeanor to occupy the posted building or structure, or to remove or deface the notice and shall be subject to Section 14 . 12 . 030 Violations and Penalties . 14 . 12 . 030 Violations and Penalties : Any person, firm or corporation violating any provision of this Code shall be deemed guilty of a misdemeanor and upon conviction thereof, shall be punishable by a fine of not to exceed $500 or by imprisonment in the Mason County Jail for not to exceed 3 months, or both fine and imprisonment . Each separate day or any portion therof during which any violation of this Code occurs or continues shall be deeded to constitute a separate offense, and upon conviction sahjll be punishable as herein provided. *Mason County Ordinance 45-99 Section 14 . 04 . 010 adopts the following: (F) Uniform Code for the Abatement of Dangerous Buildings, 1997 Edition Section 302-Dangerous Building: For the purpose of this code, any building or structure which has any or all of the conditions or defects hereinafter described shall be deemed to be a dangerous building, provided that such condition or defects exist to the extent that the life, health, property or safety of the public or its occupants are endangered. (1) Whenever any door, aisle, passageway, stairway or other means of exit is not of sufficient width or size or is not so arranged as to provide safe and adequate means of exit in case of fire or panic . (13) Whenever a building or structure has been constructed, exists or is maintained in violation of any specific requirement or prohibition applicable to such building or structure provided by the building regulations of this jurisdiction as specified in the Building Code or Housing Code, or of any law or ordinance of this state or jurisdiction relating to the condition, location or structure of buildings . (15) Whenever a building or structure, used or intended to be used for dwelling purposes, becauise of inadequate maintenance, dilapidation, decay, damage, faulty construction or arrangement, inadequate light, air or sanitation facilities, or otherwise, is determined by the health officer to be unsanitary, unfit for human habitation or in such a condition that is likely to cause sickness or disease. (17) Whenever any building or structure is in such a condition as to constitute a public nuisance known to the common law or in equity jurisprudence . i PERMIT HISTORY 5-10-99 : Building Permit issued to agent/contractor for George Royal for installation of Manufactured Home. All conditions signed for including required inspections and permit validity requirements 7-12-99 : Manufactured Home Setup Inspection approved. Temporary occupancy of 90 days given. 10-04-99 : Complaint received 10-7-99 : Notification to George Royal to obtain final No response 10-7-00 : Complaint referred to Environmental Health regarding solid waste violations . 12-01-99 : Second notice to George Royal to vacate the unit or obtain final occupancy. Sent First Class and Certified. Certified returned on 12-21-99 Unclaimed Sent First Class to site. Notice and Order for Disconnection included. 12-20-99 : In response to second notice sent to site, Alice Wilcox, the occupant called. I informed her of the requirements . She stated she will do what needs to be done. 1-5-00 : No action taken by owner or occupant. Site posted with Do Not Occupy Notice by Terry Ryan, Building Inspector. Photos taken and conversation with occupants mother regarding disconnection and the order for vacation. Photo of mother and posting on file. Photo of solid waste. 1-28-00 : Notice and Order for Disconnection was not enacted by PUD per complainant. Request for disconnect sent to PUD. 1-28-00 : PUD disconnects service. 2-3-00 : Complaint received that unit is still occupied and power is now supplied by extension cord by neighbor at 288 . Notice sent to owner of 288 to cease supply to 292 immediately 2-7-00 : Site inspection verifies unit still occupied and power provided by 288 . a.' �4 . 2-14-00 : Site inspection verified extension cord disconnected ai SENDER: I also wish to receive the o ■Complete items 1 and/or 2 for additional services.to following services for an ■Complete items 3,4a,and 4b. g y ■Print your name and acl;Z reverse of this form so that we can return this extra fee): card to you. ui ■Attach this form to the front of the mailpiece,or on the back if space does not 1.❑ Addressee's Address V d Permit. � •Write"Return Receipt Requested'on the mailpiece below the article number. 2•❑ Restricted Delivery N ■The Return Receipt will show to whom the article was delivered and the date postmaster for fee. delivered. Consult C 3.Article Addressed to: 4a.Article Nam er 7j o VILMOS & TEREZAA KEREZSI 4b.Service Type 0 980 NE SHOE LK RD #301 ❑ Registered Certified n TAHUAY WA 98588 ❑ Express Mail ❑ Insured c w ❑ Return Receipt for Merchandise ❑ COD W o RE : 288 NE TEE 1,K R D 7.Date of Delivery o a -o?UO O o' (r 5.Received By: (Print Name) 8.Addressee's Address(Only if requested Y V/4� /V 0-3 X f /L Z S and fee is paid) 6.Signature: , d ss or _ ~ 0 o X� ) ti —" PS Form 3811,December 1994 102595-9e-13-0229 Domestic Return Receipt First-Class Mail UNITED STATES POSTAL SERVICE jr Postage-&-fees Paid I USPS Permit No. G-10 •Print your name, address, and ZIP Code in this box • _ TAMI GRIFFEY U MASON COUNTY PERMIT ER P O BOX 186 ^ SHELTON WA no0� 1. 'C°s�► •�A'-►6 4+C:i 8 "IL}I1f 11111�11111IIilltl�l�l lllll l'�II III�Illllll fl�lll�)Ii"