HomeMy WebLinkAboutWall Install - BLD Application - 5/29/2000 MASON COUNTY MIS
PRE-INSPECTION APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 •427-9670
4-9 Z Fee Required prior to inspection
PLEASE PRINT ' f2-
#1 Owner Phone# '11 ? e
Site ss C��e o city�/�� �cdy
Mal Addres O rp 5"C�
city St Zip
Applicant Phone #
Applicant Address
city St Zip
#2 Parcel No. 2,(30c) —G
Legal Description �(.�?6' ��Pz2 y kk 2fz/0(_/1C
#3 Purpose of Pre-Inspection A-- �� C��G /(
#4 Use of building /,�ti
#5 Indicate by circling the applicable source if any water is on or adjacent to subject property:
saltwater lake creek stream marsh river pond wetland seasonal runoff other
Directions to Site:
Show following on the site plan below: Lot Dimensions, Existing Structures, Structure Setbacks, Water Lines, Septic Systems,
Flood Zones, Wells, Shorelines, Easements, Name of Flanking & Fronting Streets. Indicate directional by N, S, E, W, etc.
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Applicant Signature `' Date
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FOR OFFICIAL USE ONLY: Accepted by: ( - Date.
ReceiptNo. �
Referre
d To
DEPARTMENTAL REVIEW
FOR OFFICIAL USE ONLY
Proposal Proposal
Approved Denied
Planning:
Building:
Fire Marshal:
Special Conditions
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