HomeMy WebLinkAboutSPI Application - 8/25/1992 MMON /COUNTY
PRE-INSPECTION APPLICATION
PLEASE PRINT $25 . 00 Fee Required
#1 Owner f� a, 17 / ;,�t, Phone# �7f
Site Address �y Ci ty
Owner Address ✓►�e '
City r St Zip
Applicant Phone# �r--60 77
Applicant Address S4✓
Ci ty St Zip
#2 Parcel No. f C
Legal Description T P
#3 Purpose cf Pre-Inspection C'
#4 Use of building
#5 Any water on or adjacent to property: saltwater lake
river pond wetland seasonal runoff
other
Directions to Site: Z /
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Applicant Signature.- Date:
Return application to: Department of General Services
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
Include a $25. 00 check or money order payable to Mason County Treasurer
FOR OPFICIAL USE OBLY: Accepted by: Date:
APPLICANT TO DRAW SITE PLAN BELOW
Show following on the site plan
I
Lot Dimensions Flood Zones
Existing Structures Fences
Structure Setbacks Wells
Water Lines Shorelines
Drainage Plan Easements
Septic Systems
Proposed Improvements Scale:
Name of Flanking Street Date:
Name of Fronting Street
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Proposal Proposal
Approved Denied
Planning:
Building:
Fire Marshall: