HomeMy WebLinkAboutSPI2010-00084 Cancelled - SPI Application - 11/1/2010 5P 12v 10 - 00084
MASON COUNTY
PLANNING DEPT. PRE-INSPECTION APPLICATIO
PLEASE PRINT _/�,�255.00 Fee Required
1. Owner: _ D<6< ctn Applicant:�'t.,.z- f/�✓nkY�'-` �Y1.41"Y .11-3
Site Address: d�e C Applicant Address: . v � 3 /2
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Owner Address: City: t % w T—St-WA—Zip �$S 2—';�-
city:�a A I(;�-, StL RAZip Phone: 3�� y 9G)- G 00-1- day
Phone:(4/z& -7 tl Z - 6 l��7 day (3 'o :
551
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Phone ) evening P lanner
Email Address: SNIP omp.Plan Type of Use
Water Body
2. Parcel No. 06'00 f)f')3-7 -
Parcel No. - -
Legal Description:
3. Purpose of Pre-Inspection: 400 y I",
4. Use of building:
5. Do any of the following exist on or adjacent pr ?: slope ) s ater lake river
pond ) wetland seasonal other( stre seasonal creek
Directions to Site: i L �n cznZ —7,c4 Ke An C 16 e' e
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If the information is incom hen Mason Cou must disclaim any errors resulting from deficiencies.in the original
application. Pre-inspection reports remain valid o until development changes occur in the vicinity which affect the lot
evaluated in this inspection, or the laws regulatin evelopment of the site change after the time of inspection.
Applicant Signatu Date:
Ifyou would like to be on site during inspection,please check here:
Return application to: Department of Community Development, Planning Division
P.O. Box 186
Shelton, WA 98584
(360)427-9670
Please include a$255.00 check or money order payable to Mason County Treasurer
When completed,this form becomes part of the parcel file.
FOR OFFICE USE ONLY: Accepted by: Date:
MORE ON BACK SIDE
1:\PLANNING\PAC\PRE-INSPECTION Revised: 1226/08
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