HomeMy WebLinkAboutMIS93-00645 Pre-Inspection - MIS Application - 10/15/1993 MIS J -Q S
MASON COUNTY
PRE-INSPECTION APPLICATION G
426 W. Cedar/P.O. Box 186, Shelton, WA 98584. 427-9670
$25.00 Fee Required prior to inspection
PLEASE PRINT
#1 Owner L I Nto P--q c Al STt--F L Phone# '7,S- (ilk k--
Site Address �3 L/ (rp City_.. .8CZFZ F'9 I l_
Mail Address p 0 • GOx /(I (e3
City e-7 %tz--- St l/(., b Zip q Asa Y
Applicant L- t ,-; Phone# PV4
Applicant Address L(4o 3
City 6 E7 St Zip q yS);
#2 Parcel No. / 3 3 2 - - da o C f Legal Description S6 n I_Aelel-� � U�— �_
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#3 Purpose of Pre-Inspection 0hgkt j-C 04 USe
#4 Use of building Ar euV Sa LeS
#5 Indicate by circling the applicable source if any water is on or adjacent to subject property:
saltwater lake creek stream marsh river pond wetland seasonal runoff other
Directions to Site: lam' /N-C ros5 +4-4- y'1b-60e.
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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.
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Applicant Signature Date l `
I
FOR OFFICIAL USE ONLY: Accepted by: Date:
Receipt No. Referred To
DEPARTMENTAL REVIEW
FOR OFFICIAL USE ONLY
FPro
posal �,� Proposal
roved Denied
PI<. uung:
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Building: f
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Fire Marshal:
Special Conditions ib t.�ahliuwr�oh �sfa+e ernevq� �oD�
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