HomeMy WebLinkAboutSPI2008-00180 - SPI Application - 11/3/2008 S 1' i -- cc
01,/05/2007 15:50 FAX 360 427 7798 MASON CO PERMIT CTR 0002
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MASON COUNTY
PLANNING DEPT. PRE-INSPECTION APPLICATION (l
PLEAS£PRINI 5205.00PeeRnc,o:rrd "r
1. Owner- Y A!' ei r A AN ,n Applicant: L t,z ti S
Site Address:_l 3 Applicant Address:
Owner Address: 1-1 It rr a City: A/ly p St W Pt' Zap^Z Lg _
Cit-r--A St�_Zip gg41Jy Phone:( , 40 'a 77—a 3!? f day
Phone:( o) --.;)eo7 day y; l��gs�2wA+�e�6/c,cvm
evening Planner:
Email Address: SMP Comp.Plan Type of Use
Water Body
2. Parcel No.. 1.2^2 0 S`a- 90 d
Parcel No. J
Legal Description_ ]l VAn b l k, 7 9 L oTf
3_ Purpose 00re-Inspection: �CeI6(1 4 11(& ? f
D en
4. Use of building:_
S. Do any of the following exist on or adjacent to property'?: slope saltwater lake� � river{
pond( ) weCand 4C) seasonal runoff( ) other stream ) seasonal creek
Directions to JSite: lJy/1h , Se tip, do !r 3 � dr1✓e;wok y dam, s!,o
O N �N �d L t o 'Da
If the information is incomplete, then Mason County must disclaim any errors resulting from defieiemics in the original
application. Pre-inspection reports remain valid only unto development changes occur in the vicinity which affect'the jot
evaluated in this inspection,or the laws regulating development of the site change after the tinge of inspection.
Applicant Signattlta:— RVDate: f yy y'3. y
Ifyou would like to be on sije during inspection.please check here.
Return application to: Department of Community Development,Alarming Division
P:O_Box 186
Shelton,WA 98584
(3 60)427-9670
Please include a$205.00 c heck or money order payable to Mason County Treasurer
When completed, this forrz becomes part of the parcel file.
FOR OF17CE USE ONL N':Accepted by: —Date-
MORE ON BACK SIDE
1:WLANNINC.SPAC`PRE-INSPECT ION ReviseJ: 01/17106
01/05/2007 15:51 FAX 360 427 7798 IUSON CO PERMIT CTR 10 003
Please illustrate below the proposed building site in relation to water and property lines:
At
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(For Office Use Only)
Planning Deparl:ment Findings:
L•?LANNING\CHARELL&RFNE 3\PRE-INS1TZn0N Revised: 04110100
MASUN WUN I Y, WA 1/30/2009
Building Department 1:11:54PM
Environmental Health Department
Planning Department
Permit status and inspection results can now be checked on the web -www.co.mason.wa.us/permits
IP14 Building Dept. inspections requests can be made via the web-www.co.mason.wa.us/community_dev
Receipt #: S22OO8O000OOOOOO2851
Date: 11/03/2008
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
SPI2008-00180 Site Inspection Fee 001.125.145.345.83.04.0000 240.00
PRIMARY APPLICANT FOR SPI2008-00180: LUCAS,RAY
Line Item Total: $240.00
Payments:
Method Payer Bank No Account No/Check No Confirm No How Received Amount Paid
Check RAY A LUCAS SECU 1065 In Person 240.00
Payment Total: $240.00
Page 1 of I cReceipt.rpt
ON COG�v
MASON COUNTY Shelton (360) 427-9670
> ` DEPARTMENT OF COMMUNITY DEVELOPMENT
Belfair (360) 275-4467
Permit Processing/Inspections/Addressing `f
Mason County Bldg. III 426 W.Cedar Elma (360) 482-5269
P.O.Box 186 Shelton,WA98584 ,'i 7 "•!?�
426 W.
REQUEST FOR REFUND
DATE: 009
NAME:
ADDRESS: __�/ / / 1r<�•f /— t l< < L G� v�a� �I',/ /�
CITY, STATE : �� `� ZIP:
PHONE:
The applicant does hereby request a refund on receipt
Dated �� Permit # //t/S/� Issued for
Reason for Refund Request j 7L-e i n e C_
Cl n E�(
��/ 6 �' V' / �� c S C ✓ty► G''t^e�-� 6Gc
SIGNATURE:
STATE AUDITOR REQUIREMENTS
YOU MUST ENCLOSE THE ORIGINAL RECEIPT WITH THIS REQUEST
IF A BUILDING PERMIT WAS ISSUED AND THE REQUEST WILL CANCEL
THE PERMIT THE ISSUED PERMIT MUST BE RETURNED WITH THIS
REQUEST.