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HomeMy WebLinkAboutBLD97-00319 Pre-Inspection - BLD Application - 6/27/2002 MI5 1. MASON COUNTY ✓(�N�� PRE-INSPECTION APPLICATION 426 W. Cedar/P.O. Box 186, Shelton,WA 98584•427-9670$5 2.3 0 Fee Required prior to inspection �qIQ S 4 PLEASE PRINT CA #1 Owner v� Phone# Site Address oZ 3d l l� �rr City Mail Address --e City St Zip Applicant Phone# Applicant Address City St Zip #2 Parcel No.—,; Legal Description Tr. 33 ` P 75-1 #3 Purpose of Pre-In ection -DD 3 #4 Use of building #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 Sit Qd1 t r GC 7 � 0 � 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 Signature Date ' . FOR OFFICIAL:USE ONLY: Accepted by: ©ate: Receipt No Referred To DEPARTMENTAL REVIEW FOR OFFICIAL USE ONLY Proposal Proposal Approved Denied Planning: Building: /1 z --© Fire Marshal: Special Conditions k16CK.5 E06 itl 4C i/4,7 t L a -%;' w. cJ1�1J� UAL