HomeMy WebLinkAboutBLD2001-00157 Pre-Inspection - BLD Application - 2/26/2001 ,WOO/
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MASON COUNTY
PRE-INSPECTION APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 • 427-9670
y1.oo Fee Required prior to inspection
PLEASE PRINT ..��11
#1 Owner 0 `� I T i_ Phone# �p0- L/oc -7- T
Site Address City - L�i'7�
Mail Address (a 1123 E, 11--�RCrA512A LE R 1)
City StU)' Zip a P5j g�(
Applicant — ? Cl-- Phone# -3rar? �0?
Applicant Address
city �S ''�'�✓ St Zip
#2 Parcel No. `/ a i a - 7S - 190081
Legal Description 7-r2 0-/-) o 6tkYr. 15/1 o6 �5 F a q0
#3 Purpose of Pre-Inspection f /ne'_kL B L S 9 g - d 7 0-7)
#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 Site: /Cr6� 7— 2�(J
t
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.
S VB M i,--re D
Applicant Signature Date
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FOR OFFICIAL USE ONLY; Accepted by: Date „
Receipt No. Referred To
DEPARTMENTAL REVIEW
FOR OFFICIAL USE ONLY
Proposal Proposal
Approved Denied
Planning:
Building: - - - - -
Fire Marshal:
Special Conditions