HomeMy WebLinkAboutBLD2010-00657 Pre-Inspection - BLD Application - 7/28/2010 BLD 2-O(0 --
MASON COUNTY
PRE-INSPECTION APPLICATION
426 W. Cedar—P.O.BOX 186, Shelton, WA 98584 - (360)427-9670
$73.00 Fee Required prior to Inspection
PLEASE PRINT
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Owner Daytime Phone# 36 3 - 27-1 '-7— ) J u[v
Site Address 171 = ( city k,
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Parcel No. 1 'Z 2 �1 T)C� 1 3 p A;k 019 — -4 L4 — 00030
Legal Description: 1,6 r
Purpose of Pre-Inspection:
Use of Building: •S
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: " c> r4 V��3 1-. O
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Show the following on the site plan below: Lot dimensions, existing structures, structure setbacks, water lines, septic sytems, flood
zones,wells,shorelines,easements,name of flanking and grontage streets. Indiate direction by N, S,E,W,etc.
Applicant signature Date
Date:
FOR OFFICAL USE ONLY - Accepted by:
Returned to:
Recei t No.
DEPARTMENTAL REVIEW
FOR OFFICIAL USE ONLY
Planning: Proposal Proposal
Approved Denied
Building:
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Special Conditions: