HomeMy WebLinkAboutMIS93-0367 Pre-Inspection - MIS Application - 7/12/1993 M I S
MASON COUNTY
,a� L 131993 PRE-INSPECTION APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 • 427-9670 \
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$25.00 Fee Required prior to inspection �p
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#1 Owner y/n H Al Je AE"A &IS kO Phone #
Site Address —'-AS 7- 67 r/dE !,, City 4 lt*)AJ
Mail Address
City C51tME /�5 A Bel Vlo St Zip
Applicant ,bAE4 ►� ,�/5'/-n Phone # ra6`6-} .S 9
Applicant Address AM,- .45 AA6ye
city St iLliq Zip ZL,_01�
#2 Parcel No. o?�
Legal Description TZ 37 -B or s-zzkyEy VO I 1 PES a/D -.s7Z_?
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#3 Purpose of Pre-Inspection_ A9 BLE
#4 Use of building C1"y1 4'A(:;
#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: 4nz- ---=-145 i inlz A4-/0,, /2 82;; r! & /A A/ R,1 6;14 Z_
/V/10 !z /toq h DAI 72M z?.—s.0 Till F S --
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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.
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Applicant Signature Date �'
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
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