HomeMy WebLinkAboutSPI2024-00026 - SPI Application - 3/19/2024 MASON COUNTY SPI ZOM - 000zko
COMMUNITY SERVICES
Building,Planning,Environmental Health,Community Health PLANNER Ca A\i 1 N s CO V Tr N
615 W.Alder St.—Bldg.8,Shelton,WA 98584
Phone:(360)427-9670 ext.352♦Fax:(360)427-7798
PLEASE PRINT $300.00 FEE REQUIRED
PLANNING DEPT. PRE-INSPECTION APPLICATION
Note: Pre-inspection does not survey lot lines and can only provide very general septic and water adequacy information.
1. Owner: PA�q J�r-i --,� Applicant:km_ L�Z_k5
Site Address: 11 _X r,. er �. Applicant Address: l lg�, :5a-n )q't-V- Ln.
Owner Address: .l E�, 4e'm_�;nr bn City:y�)]eA-AVA St p-' _
City: St y• Zip q Phone:(6(pD ) j- 177S day
Phone:Oleo )7xy- 177,5 day Email Address: nm er;'f�c7 i cio�►d. YY1
Phone:(,,3(QO)7g-y• 1'(Ti' evening
Legal Description:
2. Parcel No. - ,(:,I,>
Parcel No. -
3. Purpose ofPre-Inspection: (A'A& .nyt, 14 Cc gCra5 l,)',rn 4:"_ r-ooyyx
4. Use of building: P6, ',w �-bDm
5. Do any of the following exist on or adjacent to property?: slope saltwater k/%) lake ) river
pond ( ) wetland ) seasonal runoff( other( stream seasonal creek
Directions to Site:
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 sit'pchange after the time of inspection.
F
plicant Signat re: Date: hik
If you lvould like to be on site during ins etion,please check here: ( )
Return application to: Mason County Community Services, Planning Division
615 W.Alder Street
Shelton,WA 98584
(360)427-9670 ext. 352
Please include a$300.00 check or money order payable to Mason County Treasurer
When completed,this form becomes part of parc 1 file.
FOR OFFICE USE ONLY:Accepted b . Date:
RE N BACK SIDE
Rev. April 2021
l
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.
Departmental Review
(For Office Use Only)
Planning Department Findings: