HomeMy WebLinkAboutSPI2014-00471 - SPI Inspections - 5/27/2004 BLD 201`+•
MASON COUNTY
PRE-INSPECTION APPLICATION
426 W. Cedar/P.O. Box 279, Shelton, WA 98584 • 360-427-9670 ext. 352
$73.00 Fee Required prior to Inspection
PLEASE PRINT
#1. Owner aJ S Daytime Phone# ,,3UO. 8( &-0531
Site Address �. '� City lu�tr
Mailing Addres 6h
City (Lavm' St Zip 8 a y y
Applica n,r, 4 „•
Address
City St Zip
#2. Parcel No
Legal Description
#3. Ru of Pre-Inspection •-{'UQ.t✓ D n 1 n m I V11:
I
#4. Use of Building ;;_RQ,n4*_0,
45. by circling the applicable source if any water is on or adjacent to subject property:
Saltwat • Lake • Stream • Marsh • River• Pond • Wetland • Seasonal Runoff• Other
Directions psite:
-fn I l oLJ -la 6Ltt )4CO r252?O n ��--
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&Frontage Streets.
Indicate direction by N, S,E,W,etc
Applicant Signiture Date '^9744,�
I:\CommunityDevelopment\Building\BuildingPreinspection
uoimdsuiold2uippg\2uip1mg\ju=dojana(J C71unurtuoD\:1
wa�1p8 to 11-Y a-lv ywoJ Q-)-
ysQd °1-
�..r•V G-"Gac7s ,,f cam.�); es s�yaJds �''� S ✓av�
fck-4 V.j �C;� 0,"v S f1 vrI Sj104Y)o
suogipuoo IutoadS
:TuqsjuW a?d
:gu!pi?ng
4
:�utuusid
patuaa panarddv
Tsodaid jesodazd AINO 3sn ivioi=i=iO �jO=i
•
a