HomeMy WebLinkAboutMIS95-0547 Pre-Inspection - MIS Application - 7/25/1995 MIS ✓ �S1
MASON COUNTY "3 C
PRE-INSPECTION APPLICATION 4 � � #
426 W. Cedar/P.O. Box 186, Shelton, WA 98584.427-961
$25.00 Fee Required prior to inspection J U L 2 b i9jJ:
PLEASE PRINT
w
#1 Owner Phone#
Site Address &1 In City
Mail Address
City St J Zip
Applicant Phone#
Applicant Address
City �— St -- Zip
#2 Parcel No. 1� 1� 2z - ,
)Legal Description
#3 Purpose of Pre-Inspection r.
#4 Use of building
#5 Indicate by circling the applicable source if any water is on or adjacent t9 subject property:
saltwater lake creek stream marsh river pond wetland a alr �other
Directions to Si
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.
from
Applicant Signature Date
FOR OFFICIAL USE ONLY: Accepted by: Date:
Receipt No. Referred To3f7
r
DEPARTMENTAL REVIEW
FOR OFFICIAL USE ONLY
Proposal Proposal
Approved Denied
Planning:
Building:
Fire Marshal:
Special Conditions
L