HomeMy WebLinkAboutSPI - SPI Application - 6/11/1992 r j
MMON cow JUN 11 1992
PRE-INSPECTION APPLICATION
PLEASE PRINT
$25 .00 Fee ReRquired VICES
#1 Owner �)EV AW l �c_i Phone# 6 6 - 9 L Z - o Z Z-D
Site Address 37,,16 IFi C E.4sr City -j��4 C o All it
Owner Address D O •CJ f
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Applicant Phone#
Applicant Address
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#2 Parcel No. -
Legal Description Lin&tit, C QC/rh. �QO T Y
#3 Pqrpose of Pre-Igspection
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#4 Use of building S',E C-C N A0
(#Si� Any water on or adjacent to property: saltwater X lake
river pond wetland seasonal runoff
other
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Directions to Site:
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Applicant Signature: Date:
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Return application to: Department of General Services
426 W. Cedar/P.O. Box 186, Shelton, Fa 98584 427-9670/1-80 2-5628
Include a $25. 00 check or money order payable to Mason County treasurer
FOR OFFICIAL USE 019LY: Accepted by: Da to:
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Show "oI-i:=w.i: i tt
g ca the s_ e plan Direc�'_ans to job site
LoC awe s-cns -1ccd Zcnes _
St=�ct•,:_-e Set, backs Driveways �)
Waver LLes Shcrel •zes
Septic SYS;,p as Wells c k 7-
0 tics Z3!;rovemeat3 Easemeazs
Name of Flanking S=eet
Name of F r-aat .ag St:eez
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Scale:
Date:
FrPL-TCANT TO DRAW TOPOGRAPHY PROFILE SELO
AL =ORTZ� _S NC': _ AND vC D_ WO�Z� OR CCNS'�RUC:'ICN
CAM_ "VCZ.; W_=� i 8 0 DAYS, OR _: CONS-,- jC_=0N Q,R WOR,� .
l S Sus?�I'?� OR A3AIV'ilON= ?0R A ?=SOD OF _90 DAYS A. ANY':'I A�'Z? W y
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CSMTRAC.ORSG2.STItAitOM Irw +tCt Tti.1T AMO AK A11AltE IN TxE STATE Of vASxING:I� AMO I AK AwItE QF Tat
OF T1IE MAsbi C?' OROIMANCE REOUIMIXT1 FOR WX(a ORDINANCE tM[XEMEMTS U-CULAT'ING TIE LMX FOB vMIQI .
THIS r•EIWI7�IS I== AND TAT ALL UM OW viLL tE Ix TIE ►MIT IS ISSM uo ALL. taltt; OONE VILL tE IN
COMFOLMANAM TIIEMITW. NO C"MMS SxALL tE KADE vI TMM C,NFCtp1AN(� TMEREVITI. 90 OIANi�S
T FIRST OBTAINING A►/RpvAL A M TIE tiJI ID I NG =ALL tE KADE
DE!•ARTMEIfT. vtTWJT FIRST OBTAINING A►rtOVAL FICA TNE. ILDING
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Retr= pe-4 t to: Depa--meat of General Services
426 W. Ccdar/P.0. Box 186, Sheltca, WA 98584 427-9670/1-800-562-5628
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Accepted Date=
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DEPARTMEI T,AL REVIEW
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