HomeMy WebLinkAboutBLD2006-01543 Pre-Inspection - BLD Application - 9/6/2006 . s . 13, MASON COUNTY
PRE-INSPECTION APPLICATION
426 W. Cedar . x 186, Shelton, WA 98584 • 360-427-9670 Q /Sy7
$58.00 F e Required prior to Inspection
PLEASE PRINT
#1. Owner Paytime Phone # 3,!
Site Address City
Mail Address m y.' ,�,
City St /�. _ Zip
Applicant er
Applicant Address
City St Zip
#2. Parcel No. Ot-'9
Legal Description t:z ` J i r
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#3. Purpose of Pre-Inspe tion b sz r
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#4. Use of Building
#5. Indicate by checking the applicable source if any water is on or adjacent to subject property:
['Saltwater ❑ Lake ❑ Stream ❑ Marsh ❑ River ❑ Pond ❑ Wetland ❑ Seasonal Runoff❑ Other
Directions to Site: p p_
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
directional by N, S, E W, etc.
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Applicant Signiture '� Date
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Fire Mar,lal:
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Conditions
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HOOD CANAL
�E 200'
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Proposed
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50' 34'
HIGHWAY 106
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