HomeMy WebLinkAboutBLD2011-00849 - SPI Application - 10/14/2011 • '� `� BLD LtSI I CJ`��
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 `c i L c Naga✓ Daytime Phone# 31.0 J:136-97444 (-1C71r_rV
Site Address p o90 54A46 R.«'fit 0/D 6 city LW:"
Mail Address 3 aL I of ��t �j Lv� S6 N�� q
city wr%W.4 t1� State �JUA-SN-.W 6 o� Zi {S�� l
Applicant ,'L A. !W/� C L,,.,..
Applicant Address 3 9 1%/ 140 L '?S L.u D S p. 114
city Gtnu�up.t�iL<< State WA-5 if vw6�a^/ zip / �So
Parcel No. : V a�� T �— 0�0'3 0
Legal Descri tion:, IR. 3 dT Ge v, Lo"I'. p f. . E-jG _SA
Purpose of Pre-Ins ection: T .e��uCvf-P.dy e,Klsf-j' SfyUG7�C�✓e, T� �(/�a
Gc>i r� v�re
Use of Building:
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: 4 oAJ ,."t't /06 C ":w✓ — A?eA.V cl.q 4-l-&* acM
ALOS&%R."" : NN
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.
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Applicant signature V v` Date 1 GC" d-�►
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Date:
FOR OFFICAL USE ONLY - Accepted by:
Returned to:
Receipt No.
DEPARTMENTAL REVIEW
FOR OFFICIAL USE ONLY
Planning: Proposal Proposal
Approved Denied
Building:
Fire Marshal:
Special Conditions:
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