HomeMy WebLinkAboutSPI Application - 12/6/1995 MIS
MASON COUNTY
PRE-INSPECTION APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584. 427-9670
$25.00 Fee Required prior to inspection
PLEASE PRINT
#1 Owner !is�,'d� �, d- y��1.,,,. I Gi., s� Phone# Z- 3 l ��
Site Address G -?- l t S}— City
Mail Address
City '.�'-A yy'_ Zip 1�51 Z
Applicant /-- t(;, _-� �cn Phone# S-4-✓►-Le-
Applicant Address VYI
City St S wti F
#2 Parcel No._3 32 3 2 - S—Z
Legal Description
#3 Purpose of Pre-Inspection 4-& N c �< �v f 7- tl i'ns� ion
#4 Use of building5P.�-i -S
#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: `�
zz
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.
Applicant Signatur Date ��
FOR(3Fi=tCIAL USF.ONLY: Accepted by: ' Gate:'
Receipt Na, Referred To
DEPARTMENTAL REVIEW
FOR OFFICIAL USE ONLY
Proposal Proposal
Approved Denied
Planning:
Building:
Fire Marshal:
Special Conditions