HomeMy WebLinkAboutMIS94-0084 Cancelled Pre-Inspection - MIS Application - 12/2/1995 �� ��✓�2,9 MIS
MASON COUNTY
PRE-INSPECTION APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584. 427-9670
$25.00 Fee Required prior to inspection M'� Dp
PLEASE PRINT
#1 Owner ck,SD-rN f �t��1 —0-\ Phone# -7
Site Address W G l VI-LI O V 6, S�P_`R� r Hwy City
Mail Address p�c`� r23bk
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City `�. '-1 F-S'c'}-F St Zip
Applicant -_)cSD-% _'h VNI Phone# Q-72 " C4-1/
Applicant Address (N E a« 14,o ,
City Be,tG4� St L'D'=, Zip '18
#2 Parcel No. 12 370 -_` z - d d w
Legal Description �✓ 2
#3 Purpose of Pre-Inspection �C�c�'�& ►`�'� ">fl�' f `-E'��
#4 Use of building i�e5 1 Coe `c
#5 Indicate by circling the ap licable source if any water is on or adjacent to subject property:
saltwater lake cre stream marsh river pond wetland seasonal runoff other
Directions to Site: 1 _ e_
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.
Applicant Signature °K-I' Date
FOR OFFICIAL USE ONLY: 'Accepted by: t7ate:'
Receipt No. Referred To
DEPARTMENTAL REVIEW
FOR OFFICIAL USE ONLY
Proposal Proposal
Approved Denied
Planning:
Building:
Fire Marshal:
Special Conditions h ro J J
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