HomeMy WebLinkAboutSPI2008-00002 - SPI Application - 1/10/2008 S �?_r '�V Ll ')u C)c �' MASON COUNTY
PLANNING DEPT. PRE-INSPECTION APPLICATION °p
PLEASE PRINT S205.00 Fee Required
1. Owner: D L t 6 a,,,-r— :J Ll C Applicant:
Site Address: E ,f 9/ + A 4 s o ti At/ Applicant Address:
Owner Address: City: St Zip
City: ,(3 4, .L St Zip � a J') Phone:(_ day
Phone: e o ) day
Phone:(__ .ry,1-7 o� evening Planner: n _
171 Fm 1, Address: PC? ?jr x j q Aa2 !SW Comp.P1 Type of Use _ rck
Water Body. '
2. Parcel No. 122 Of - 94 2 - C 20 q Q
Parcel No. - - /Jq A, V<Q
Legal Description: ' er L--O}ktt-uo - �. 1�Ci 1� R ,_rr l 20
3. Purpose of Pr e-Inspection: T o S e,o, .7 C AOFFICE
4. Use of building: 7
5. Do any of the following exist on or adjacent to property?: slope(X) saltwater( lake( ) river( )
pond( wetland( ) seasonal runoff( ) other( ) stream ) seasonal creek(X)
Directions to Site: 3 r s sk -x-
�cc2,Ts 1- e1'
w -3 rti ti T�?As' f
If the information is incomplete, then Mason County must disclaim any errors resulting from deficiencies in the original
application. Pre-inspection reports remain valid only until development changes occur in the vicinity which affect the lot
evaluated in this inspection,or the laws regulating development of the site change after the time of inspection.
Applicant Signature: , ,/� �c�Y-P _ Dater ID SA�J c�CQ'
Ifyou would like to be on site during inspection,please check here: 0
Return application to: Department of Community Development,Planning Division
P.O. Box 186
Shelton,WA 98594
(360)427-9670
Please include a$205.00 check or money order payable to Mason County Treasurer
When completed,this form becomes part of the parcel file.
FOR OFFICE USE ONLY: Accepted by: Date:
MORE ON BACK SIDE
Revised: 01/18/06
Please illustrate below the proposed building site in relation to critical areas (slopes, streams, lakes,wetlands, etc.)
existing improvements, as well as property lines. APPLICATIONS SUBMITTED WITHOUT ADEQUATE
ILUSTRATIONS WILL NOT BE ACCEPTED AND WILL BE RETURNED TO THE APPLICANT.
A4So k-
T s�
R d
��3�y � A,
N
yu s"
Tom_..
i
Departmental Review
(For Office Use Only)
Planning Department Findings:
Parcel 1 : That part of the Southeast B� � _--
T�°i ;;k w;
quarter of the Southeast quarter o- a Kr r s .° P ,- "-
Section 6 , Township 22 North , Range 1 ¢� K.F. SEA TL
West , W. M. , lying Westerly of State -Route � Bre erto� a- "I s°": "°-
No . 3 and Northerly of the Souther;,-y line �� r 3 Porto e '�u.
Mts.
of easement acquired by USA by instrument faM 160
dated March 18 , 1943 and recorded in Volume vot M�
80 of Deeds , Page 277 ; EXCEPTING THEREFROM W�-j-EQ m W P ° *=Ve
tract conveyed to USA by deed dated Febru- rAt�l►G _ _. c^' s "aft
ary 15 , 1951 and recorded in Volume 136
of Deeds , page 162 ; AND EXCEPTING _also r ` IC11111` .6
therefrom road rights -of-way. o MAP ACaMw
--------------
Parcel 2 : That portion of to FZ A,
quarter of the North half of the South-
east gOarter of Section 6 , Township 22 r� F-tAF2KE�
North , Range 1 West , W.M. , lying 1t7Esterl
of Secondary State . Highway No . 14 -1, and
Easterly of road commonly known as Razor
Road ; EXCEPTING therefrom tract conveyed
to ;Michael N. Fleury and Patricia Y. Fle ry;
his wife , by deed dated November 15 , 197
under Auditor ' s File No . 26-5431 ; ar,d
excepting also therefrom road rights -of- y.
(2 11, 446 AC-IaES
SCALE 1II i 00' PAIL
C Q �K
EA 2 4,ft
5
U
H lCrHW�Y 5 A LLEN I MILE TO BEL a R
�ad�..,o�.w.. .V...y/< y "rind► ..r4. �`.rs�.�
SOS
COUP F
MASON COUNTY Shelton (360) 427-9670
DEPARTMENT OF COMMUNITY DEVELOPMENT E C E!V E D Belfair (360) 275-4467
Permit Processing/Inspections/Addressing Elma (360) 482-5269
Mason County Bldg.III 426 W.Cedar 'JAN
1854 P.O. Box 186 Shelton.WA 98584 2 C3 ?(I[�n(Q
476 W- CEDAR ST _
REQUEST FOR REFUND
DATE:
NAME: L-) k-'��
ADDRESS :
CITY, STATE: Ctc ?� A 1 r'?� �Z1yL. ZIP: l 651-L8
PHONE: 3WL I 7 5.
The applicant does hereby request a refund on receipt
Dated I-ID-D Permit #jl� I .� ti ;� .� Issued for
Reason for Refund Request
}} ' L f
SIGNATURE:
STATE AUDITOR REQUIREMENTS
YOU MUST ENCLOSE THE ORIGINAL RECEIPT WITH THIS REQUEST
IF A BUILDING PERMIT WAS ISSUED AND THE REQUEST WILL CANCEL
THE PERMIT THE ISSUED PERMIT MUST BE RETURNED WITH THIS
REQUEST.
� � Z 0T � �.