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Home My WebLink AboutBLD94-01703 Cancelled ATF Mobile Home - BLD Permit / Conditions - 1/6/1999 MASON COUNTY Mason County Bldg. 111 426 W, Cedar P.O. Box 186 Shelton, Washington 98584 L, F, N 1) in st 1j 4 1 r&_ P L _& PLATiCOPLO DIV - BLK : L.0 11' JOB ADDRESS : NE 1461 COLLINS I,AKU DR TAHUYA OWNERS LEE CARSON 478-2718 CONTRACTOR L E ct U- CLAS,"; OF WORK , , :NEW BFDRt 2 BATH - I JTYPE ANOVIII 9Y OAT[ RECEIPT 1YPi AMOUNT BY DA0 liffilpli tYPF ")F -USE' . t MH STORIES — . . . . : I OCCUP , GROUP . . . !7 BLDG . HEIGHT . . - O .Oft, limor s iecos cpn sqtwo 40281 TYPE OF CONST . :7 FIREPLACES . . . . : 0 SIFF 1 4.59 CPH #9120195 40281 OCCOP . LOAD . . . 0 WOODISITOVIFS , . . . 0 DWFtt .IJNITS , , . . : 0 PARKING SPACES : 0 INSPECTION AREA : 2 SHORFtINF? . . . . :Y 140TAt: 104.50 VALUIA11011. L r ,— �—�--A# TOILETS . — . . . . . . s 0 FUEL TYPES----------- 801 LERS/COM11--- MOBILE HOME- -- F R 0 N T 'S, 10 .Oft BATH BASINS . . . . . t 0 0--3 HP . : 0 REAR . —N 10 .0ft BATH TUSS . . . . . . . . : 0 3-15 Hf` . , 0 MODEL : SIDF ( 1 ) ,E 10 .0ft SHOWERS . . . . . . . . . . . 0 FURN < 100K BTU ; 0 15--30 HP z t 0 -MA K F--I------ SIDE (2) .W 10 ,ort WATER liEATERS . . . . , 0 PURN --100K BTU - 0 30-50 HP . t 0 PAC IFICA SF-IRL I NE 0 .0-rt CLOTHUS WASHERS . 0 FURN - ULOOR - - , t 0 50+ HP , - 0 - y J7 A P- AREA KITCHEN S I NKS . . . 0 HEAT -PIJMP . . . . . . : 0 70 LOT 817F — s FI. 00R DRAINS . . . . . . 0 VENT SYSTEMS . . . : 0 EVAP COOLERS : 0 LENGTH ;55 BUILDING — : 660st DRINKING FOUNT . . . : 0 VENT FANS . . . . . . % 0 HOODS . . . . . . . : 0 WIDTH , 02 BASFMFNT . , , : Ost LAUNDRY TRAYS . . . , 1 0 DOMES . INCIN :O - '317-A I At, 'DECKS . . . . . . : Osf DISHWASHERS......DISHWASHE.RS . . . . . . s 0 AIR HANDLING UNITS- - COMML . INCIN .0 GAP/CARP :? 0 s-I` GARB r) l ','POSALS , - . 0 � v 10000 ufn) , -, 0 AFtOC/RFPAIR : 0 AT/DT , t7 URINALS . . . . . . . . . . . 0 > 10000 cfm , : 0 OTHER UNITS . : 0 MISC PI.M FIXTURES - 0 GAS OUT I F IS 0 PROJECT DESrl1IPTIO1t*AFTf1 THE FACT' MORRE 11011F PE11111 PROJECT 0CAJIONtf(11101 fffINDAfit PASS 90 TO COItINS 1AI(F DIRECIION OF SIGNS. 10100 PFINIF BECO0911111 AND VOIlk IF MORN OA CONSTRUCTION AIJIT061117ED IS NOT COVIENCE8 WITHIN lit DAYS, 00 If CONSTRUCTION OR 108Y IS 5113PFADEP FOR A pipm OF 186 DAYS AT ANY 110t AFTER 1019 IS CO11rkCFV fvlDfNcf of CONTINUATION or Im Is A PROGRESS INSPECTION 111111111 TO IRO IIAV MR109. FINAI lllSPFCIIAII 1100 Rfl APPAOVFD Sil"011f BIJIL8116 CAN Of OCCUPIED: OWNER 00 Allfolt 4 81.0-PRIII, rev; 03131191 COMPLIANCE TO ATTACHED CONDITIAS IS'/4(EQUIRED CONCRETE MECHANICAL MOBILE HOME Footings-Setback date by Ribbons r� date by Gas Piping date — 7 b L 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 OTHER Groundwork Attic date by date by D.W.V. WALLBOARD NAILING date by date by Water Line FINAL INSPECTION date by date by date by �`tS Building Permit # MASON COUNTY BUILDING III 426 W. CEDAR SHELTON, WASHINGTON 98584 (360) 427-9670 CORRECTION NOTICE Job Location lq6( Co /I i'-:, s L-,:- & -c_ Dr- This structure has been inspected by Mason County Building Department and the following VIOLATION of County Laws and Ordinances has been found: I ms listed below must be corrected to gain code compliance t 7 le s.� 4�a 4,--"T rD J"�c 4c.r mac.. v n S S D e--� r'4.. O-n e a r S"5 t D1'ri JI'c—-e-- 4-r- - 4 / a,( L t�' no s. You are hereby notified that the above corrections shall be made BEFORE PROCEEDING WITH ANY FURTHER WORK b . ��.5 ll S �:1-- f CJ 1 zG„5 Call for re-inspection when corrections are made before continuing ❑ Make corrections, items will be checked on next inspection ❑ OK to �A Department Date b- 1 7—z6 Inspector �- ■ oo * NnT MOOV THV TmL0111111111' MASON COUNTY Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 fits_. 7 W_09.4 - I l 0 f car : t EE CARSON Page - I 1 ) Sub iert to c;ond I t i one, of Resource Lands and Cr I t i caa I Areas t RL.C ) Check 1 I st not i f 1 carat i on I Pi ter . X 1 ) The u'.e , hand I i ncl and storage of hazardous, miter I a 1 S or F I ammab i e and combust I b l e Iiqul (is in excess of 10 galions Is not allowed without the approval of the Mason County F i r,i Mar-uha I , f 3 ) Structure must be setback 5 ' f rom all ut t I i -ty and dr-a i nacie na!>ement s , .a total of 10 ' from all property llnes , or a variance must be obtained from the Building Department . X_�_-___._._.__w_...__.. 4 ) Subteot to conditions of Resource Lands and Critical Areas (P.I.C ) Checklist . RLC44-16r4 5 ) Propo:..ed structure or, any port Ion thereof greater than 30" in heic)ht from grade- lute , must sacra i nta s n a in i n Imum of ti ' setback from a I I property I i ner , easements and r I ght cif ways . 6) ' Pt1R>�ANT 40 1991 UNIFORM PI) 1 1.-li t NG CODE , SECTION 30,1)( 0 ) AND SEC`I ION r,1 3 . Ali- S 1 `I'F S MUS`f HAVE APPROVED NUMBERS OR ADDRESSES PROVIDED IN SUCH A POSITION AS TO BE PLAINLY VISIBLE AND LEGIBLE FROM THE STRFF`T OR ROAD FRONTING THE PROPERTY . MASON COUNTY BUILDING DEPARTMENT REQUIRES THAT THIS BE COMPLETED PRIOR TO CALLING FOR ANY SITE INSPECTIONS . A RE 1 NSPFCT I ON FEE , BASED ON RATES IN TABLE 3A OF THE 1991 UNIFORM BU 1 I_D I NG CODE W 1 LI BE ASSFSSED IF OWNER/CONTRACTOR FAILS TO POST ADDRESS ON SITE PRIOR TO RF..OUESTING INSPECTIONS . _ l 7 ) AL I CONSTIlUCT I ON MUST ;MEET OR EXCEED Alt. LOCAL CODES AND Obc XC0U I R,.E:MENTS 6 ) All moblIo/manufactured home I and ings or decks must be freestandIng ( se If supportIrig) MASON COUNTY Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 The i arje-,t landing or dock < i t r S { Ar p 1 with :r ig btai idin � n Writ i �� 36" x :i6" Ate r 3atr i tlla op d(aQk t l,ai Ifs 314 or -ci p- i R t requ r e(, a (juar(irai i ! ray landinq or *lock It': 4 or r i . Any handing lw deck lamer than 3f" x 36" must he Bermitted whiotr i e(tuires str uf.;tm a drawings and a building permit application . This Installation Permit does NOT Include any landing or deck I rarger than the 36" x 36" size . X 9> TFI I 1 1 9 BEING CLASSIFIED AS A 14ON-CONFORM i NC USE PFRMI ..t AND HAS NOT HAD A FIRE 'SAFF1 Y I NSPF��i ON F OM t.R i 1ND HAS BEEN PLACED ON SITE PRIOR TO MASON COUNTY 4RRD i NANCE , t.i8 92 1 COLLlflS LAKE -f - --�- twEIGNBOR'^ tS ti DOC K I SLASH 1-5 �I I' � � a ►- a a - lu 0 of it p I .I ,4--CO�L�NS LAW DRIVE--*- LEE R. GARSON N I"=20" COINS I-AKE SITE PLAN ATTN. FD PII-AND �r may, � L �r a '� i ,� t crwy �• � t �-• � , -C� � Ay _ '. i i M A S O N C O U N T Y COMMISSIONERS ROBERT C.OLSEN WPUBLIC HARVEY H.WARNACA JOHN H.WHALEN MANAGER LITY DISTRICT EDWIN E.BLAKEMORE November 6, 1994 Lee R. Carson 1012 Pearl Street Bremerton, Washington 98310 Dear Mr. Carson: A proposal of cost to install electrical facilities to your property located at NE 1740 Collins Lake Drive was mailed to you on August 12, 1994. To date, you have not accepted this proposal. As our proposal of costs are only valid for 30 days, and you have gone past the allowable time limit, we are sending you a reminder. If we do not hear from you by November 21, 1994 we will cancel your request. If you cancel your request by not responding to this message, and wish to pursue this matter at a later date, a new application and a new application fee will be required at that time. OUR POLICY IS CHANGING DECEMBER 31, 1994. IF YOU REAPPLY AFTER DECEMBER 31, 1994 YOUR PROPOSAL COULD CHANGE SUBSTANTIALLY. Sincerely, 4uA.A� Karen L. Burns Senior Service Coordinator klb P.O. Box 2148 • Shelton, WA 98584 (Bus) 206/426-8255 • (Fax) 206/426-8547 Permit No. ft, g - 1 cs MASON COUNTY Awppplo* BUILDING PERMIT APPLICATION 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 PLEASE PRINT � ^� feat #1 Owner (� P Phone# ,o wdr,4 Site Address Fire District# c3 City ` St Zip Directions to Job Site 04 Owner Mailing Address ltT�J City ��ft��C,�'�g�z.—" Gam;p� St_� Zip Lien/Title Holder SSG yr��t� �1lG 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 Connect to Sewer System? Name of System .�Q (If residential, proof of potable water is required) #4 Parcel No. - Legal Description #5 Building Square Footage: (existing/proposed) �A/,4 �� l�`'�7�'L� ��+'� UG'��Y'1 1 st FI / 2nd FI / 3rd FI / Loft / Basement / Deck / #bedrooms / #bathrooms / Garage / Carport / (Circle:Attached or Detached?) Othersq. ft. W Titc+ "bx #6 Use of building Descri k APR, Alxe- :�wF dA #7 Type of Job: New fAdd Alt Repair r Other #8 MOBILE/MANUFA�C'TURED ME INFORMATTON Model Year Length Width ,z Serial No. #Bedrooms _#Bathrooms Type of Heat Jd Purchase Price $ #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 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 Indicate Directional by N, S, E, W Name of Flanking Street ) Name of Fronting Street in relation to plot plan APPLICANT TO DRAW SITE PLAN BELOW \, V 0 G AeJ4 7'} 4 �- !ti L�PGl APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW P11 rrrbing Fixtures ($,3 each) FeeM_echanical Fixtures ($6 eachl No._Toilets CIRCLE FUEL TYPE: Gas, Electric, _Bath Basins Heatpump, Other Bath Tubs No. Units Fees _Showers Furn BTU _Hot Water Htr _ Heatpumps _Laundry Washer _ 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 15.00 _ Auto Fire Sprink Sys 25.00 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 15.00 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 I 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 I RCW 18.27, AND AM AWARE OF THE MASON COUNTY AM AWARE OF THE 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. XOWNER '44_ XBY T r DATE DATE i FOR OFFICIAL USE ONLY: Accepted by: Date: DEPARTMENTAL REVIEW FOR OFFICE USE ONLY ' Approved Cond. Hold Approval Planning: Environmental Health: 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 Other Other Building Valuation: TOTAL FEE COLLINS LAKE , +NfIGHBOR.�,. DOG K N i 1 F SLASH k � RI I � 1 I � Y 1� 1 I I 1' 1 1� I) 11 � 1 11 1 11 I I I 'I 1 1) _ 1'I 1 11 _�1 �' Il I � 1 r / 1 \ 4--COWRS OAKEF DRIVE-- LEE R. GARSON I COW-.INS LAKE SITEPLAN ATTN. F=D PI!-AND .Dcpurtmcnt of Labor&Industries ELECTRICAL 7 2.713 � Electrical Section WORK PERMIT APPLICATION t................................y..............................-..-..... . ............................ _............ "- s due now Will call Read *.i Insullatron description Today' ' ::............................................... . .. .... • Electrical contractor Owner 1 Phone No. ._l�s�ov Job wired by i� , 7 `.....................................�............................................................... Address of inspection i i•' �.r ....'�.r�....�.....` t:....}...I . ............................... ....................................................................................................... y^... County :`.r)�.�.................... ............................................................................................................................ .................................................................................... _ •Premises ownei s name i� r.. f ''r./ .....................y................................................................ .................................................................;.. apeeii9ritee......................... \, .......... ... . Electncal contractor name $ },. t lr r.,Ss l; (r. C.(. C(.rT� �fl � r • purchaser's mailing address Becomes permit when properly validated. �').>X ! :1 r� Expires one(1)year from date of issue. ........... ......................................... City State ZIP+4 Department use only .............d0.8........C�fa.:ads' . ................................. Power company f.......f .... .:...........�~......................................................................................................... I hereby certify that I am the owner (or authorized agent) of the above named property or a licensed electrical contractor(or the firm's authorized agent)and am rpaking the electrical installation or alteration in compliance with the electrical law, Cha ter 19.28 RCW: .................................................. i Sij�oiture of-home owner or adrfiinisiiii6r ` i t 4 A., / . White-sery loc Pink-customer Canary•inspector Grcen•job sitc ........ ".1.............•WALLS........ /,2............'CEILING .....:........ •� i• ................ POOL......................... r.4..........SERViCES............ Overhead i Insulation Only ( Insulation Only Bonding Only ` i e�B -- — Date approved tly Uate pprov y t ; Due �rov�� ' Cover -�-Date�uipment Onlyrov Y Underground KI 1 Cover !' i ........................ %.......... ' . i.................. Approve : j;; i � ro6y • ...D.ue. .A..... ..•.H...' ... ............. ...... Due rovY ............. ........ . ............Date Due ......................... p ........ . t 'g SLAB CH ~�', 7 FINAL `. %�8 TRANSFORMERS/ �l ' GENERATORS Cover Cuvcr tt ioved.g....i at `.�S.. Approved.. . 1 ? ... Due ... p ro—ved lay / bue....................Approved�— : .........-. Y �. Date App Y/ _....................... .........................._. ........... :.:.:.:................ . 12 .............OTHER ................_...........-....-..................... ,....................... ..............................-, ....... 9 FEEDERS/ ;, ;' 10 O ILE HOME,/ V ', r 11 SEE - ~'t 3 SUBPANELS ervice On PROGRESSIVE '11 i f I REPORT i '• e A rov i iFee er i ................................................ �Y;.-•- ...... ..... ...................................................... ...............:..... ........................... ate A d � t J� Date Approv rove ui By pp roved ♦., ................................../ ....................................................... Inspection E Area,Building,or Action Taken Approval No. ate_ ( Equipment Inspected _r PP i f i l e ...........;........................................................................................................... ..........................................................................i.......................................... ' o �;.......r.................................. V\., POST THIS COPY ON JOBSITE. t •% ..... .::......................................... . . ............................. ....... THIS IS YOUR PERMANENT RECORD F5o0-ool-000 electrical work permit application 6/92 i JOB SH F I the mason county assessor Darryl Cleveland Dear We have received a copy of" the tax certificate for movement of your mobile home . In order that we may accurately value your mobile home . please complete the questions below and return this form to our office by This information is imperative to prevent a possible double assessment on your mobile home . MOBILE HOME DATA LENGTH WIDTH MODEL _— MAKE MODEL YEAR 1� MOBILE HOME LOCATION INFORMATION SERIAL A . My privately owned land yes no OR B . If rented or leased land who from? NAME ADDRESS CITY & STATE C . Real Property Parcel # �"� 31-g'�/- �)��/ ( from tax statement of new location ) D . Mailing name/and address for owner of mobile home NAME L �� C�✓�25�� ADDRESS C�� 0.J CITY S STATE E . Location address of mobile home City F . Date mobile home was placed on present site G . Purchase Price DATE SIGNATURE TYPE OR PRINT NAME TELEPHONE NUMBER 11 J!l 1 5 11 Permit No. MASON COUNTY ) NOV 14 199a BUILDING PERMIT APPLICATION r 4-26_W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 #1 Owner / _ <'I 2,1 Phone# ite ddress J W 7 Fire District# ity T St Zip Directi fns to Job Site '+✓ =� ' � Owner: ailing Address r peeo'."elT City St Zip J/ Lien/Title Holder e Address City 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 Connect to Sewer System? Name of System (If resi ntial, proof of potable water is required) 4 rceI No i - - (If Description (� ll #5 Building S uare Footage: (existing/proposed) 1st FI_('/ 2nd FI / 3rd FI / Loft / Basement / Deck / #bedrooms / #bathrooms / Garage / Carport / (Circle:Attached or Detached?) Other sq.ft. r � #6 Use of buildings -IC)L Describe work #7 Type of Job: New Add Alt Repair Other 8 MOBILE/MANUFACTURED HOME INFORMATION Model Year Make Model §G/ GLG Length Width ,z,Serial No. # Bedrooms -Z- # Bathroom) Type of Heat E letr� C Purchase Price$ 44�4 eAL- Indicate by circling the applicable source ifany water is on or adjacent to subject property: River Pond Creek Stream Wetland La Marsh Saltwater Seasonal Runoff Other 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 l Plumbing Fixtures ($3 each) Fee Mechanical Fixtures ($6 each No. ets CIRCLE FUEL TYPE: Gas, Electric, _Bath Basins Heatpump, Other Bath Tubs No. Unita Fees _Showers Furn BTU _Hot Water Htr _ Heatpumps Laundry Washer _ Vent Systems _Sinks Spot Vent Fans _Floor Drains � Boilers/Compressors _Laundry Basins _ P _Dishwasher N it Handling Units _Disposal _ cfm# Urinals h,Q,, Fire Protection Systems _Other Auto. Fire Alarm Sys 50.00 Fixed Fire Supp. Sys 50.00 Permit Basic Fee 15.00 Auto Fire Sprink Sys 25.00 TOTAL PLUMBING $ No. Other Ohs 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 15.00 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. WNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I 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 I RCW 18.27, AND AM AWARE OF THE MASON COUNTY AM AWARE OF THE 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 X BY DATE DATE FOR OFFICIAL USE ONLY: Accepted by: Date: DEPARTMENTAL REVIEW FOR OFFICE USE ONLY Approved Cond. Hold Approval Planning: SIn):, ;eC 4 4n R LC- 9 4 S►ruo�„1�z Y11 �aIR 09 r^o c�by s 4rj� I are �CL�1 eF�ac►�11—/(�xi I�v�a��c V C V,L Q'I g: 1 C 0 i K(Z.'� GvVI Yoi_ U.�/��v3 6'V s Environmental Health: NcTE-, 0e a,`jvS AAX6- i5 crn cSrl i 5S UHF I '5 T A� Tp7w c4- ` 4b `O 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 Other Other Building Valuation: TOTAL FEE 1INVESTIGATION REPORT FORM Revised 12/03/92 ... Statement of Policy..................................................... ..................................................................................... ...........................................................................:::::......... .............. .............................. ........... .............. :::::::::.................. ............................................................................... ........ ................... "It is the policy of Mason County to provide 'a means that we will investigate and resolve concerns ex; timely man- ner and with courtesy, objectivity, and equi' ommissioners .......................................................... Part A: Nature of complaint ................................................................. ................. • Initiator's Name: • Address: • Telephone: • Department of Concern: 11 Clerical Building LJ Health Comm Development 11 Fire • Area of Concern: Process Delay Personnel Policy/Fee Code Violation r] Other • Location of C rn: I V, • Nature f Concern: DoohA a cy_� ov .......................................................................... Part B: Concern Intake and Referral .......................................................................................................................................................... Received By: Referred To: Response Date: .................................... Part C: Findings .......................................................................................................................................................... Referral Forwarded to: El N/A Findings: &A r ........................................ Part D: Resolution .......................................................................................................................................................... Intake/File Copy-White Referral Copy-Yellow Referral Copy-Pink Tracking Copy-Gold