HomeMy WebLinkAboutPre-Inspection Add Restroom and Expand - SPI Application - 1/22/2005 - l
---ft-7'21/2005 15:27 FAX 360 427 7798 MASON CO PERMIT CTR Z002
MASON COUNTY
PLANNING DEPT. PRE-INSPECTION APPLICATION
PLEASE PRINT
S205M Fee Required
1. Owner: Applicant:
Site Address:_ � F3e�,`r• Applicant Address: E, S
Owner Address:_lam 1*, Li, 11 ow J2t(. City: ( r St Zi
Phone: BW
Uc 1 r St t A Zip cl 7-v --g6Sr Phone:_ C� �l?fl -S P ay
-�—� day Phone:_( ,d ) - evening
2. Parcel No. / L27!(o D 34.0 -.27/- 766 q Cei/
Parcel No. Email Address:_ � /, /,o j/,jw d C A.J
Legal Description: Planner:
V C00C 1 103 A P3 IF3-L _
SMP Cone.Plan Type of Use
Water Body
3. Purpose of Pre-Inspection: o
ek
i' ,11 -er
4. Use of Building: -5 , -1 0 F a rfAd
5. Do any of the following exist on or adjacent to property?: slope W saltwater{ lake river
pond( ) wetland ) seasonal runoff W other ) stream( ) seasonal creek
Directions to Site: AJC by d42i6 54,h6 Ctloi
is
And
2t�t_�Frt
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If the information is incomplete, then Mason County must disclaim any errors resulting from deficiencies in the original
application. Pre-inspection reports remain valid only until development changes occur in the vicinity which affect the lot
evaluated in this inspection,or the laws regulating development of the site change after the time of inspection.
Applicant Signature:
Date: Z.
If you would like to be on site during inspection,please check here: (vl
Return application to: Department of Community Development,Planning Division
P.O.Box 279
Shelton,WA 98584
(360)427-9670
Please include a$205.00 check or money order payable to Mason County Treasurer
i
When completed, this form becomes part of the parcel file. i
FOR OFFICE USE ONLY: Accepted by: —Date:—
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1:\PI ANNING\CHARF,U,&RENEETRE-INSPECTION
Revised: 11/15/04