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HomeMy WebLinkAboutCOM2011-00045 - SPI Application BLDNfn ao11 -a015 MASON COUNTY PRE-INSPECTION APPLICATION 426 W. Cedar—P.O.BOX 186, Shelton, WA 98584 - (360)427-9670 $73.00 Fee Required prior to Inspection PLEASE PRINT Owner. } ©4 Daytime Phone 632 O 8 DO Site Address city Mail Address city State WA Zi q `'l Applicant O (��� ✓�✓ ✓I Applicant Address 0Z 1 S 131 s ti f city SEE q.?- C.0 State nwA lZip � OJbz Parcel No. : Q — - (/ Legal Description: Puipose of Pre-Inspection: S f lid Use of Building: S 6 oo L Indicate by checking the applicable source if any water is on or adjacent to subject property: ❑ saltwater ❑ lake ❑ stream ❑ marsh ❑ river ❑ pond ❑ wetland ❑ seasonal runoff ❑ other Directions to site: Show the following on the site plan below: Lot dimensions, existing structures, structure setbacks, water lines, septic sytems, flood zones,wells,shorelines,easements,name of flanking and grontage streets. Indiate direction by N, S,E,W,etc. Applicant signature Date Date: FOR OFFICAL USE ONLY - Accepted by: Returned to: Recei t No. DEPARTMENTAL REVIEW FOR OFFICIAL USE ONLY Planning: Proposal Proposal Approved Denied Building: Fire Marshal: . 1 Special Conditions: