HomeMy WebLinkAboutSPI2024-00108 - SPI Inspections - 10/18/2024 MASON COUNTY sPi_aa_ - opt ce
COMMUNITY SERVA9C E I V E D
Building,Planning,Environmental Health,Community Health 0 C T 18 2024 PLANNER
(�� )� ✓�
615 W.Alder St.-Bldg.8,Shelton,WA 98584 �-
Phone:(360)427-9670 ext.352♦Fax:(360)427-7798
PLEASE PRINT $300.00 FE
=;V. Alder Street
PLANNING DEPT. PRE-INSPECTION APPLICATION
Note: Pre-inspection does not survey lot lines and can only provide very general septic and water adequacy information.
1. Owner: \K Applicant: ��PEti �
Site Address: Applicant Address: g Ao a N.W,
Owner Address: City: Qb�A 08 St VJA Zip T 2
City: St Zip Phone:(-qoo )_ 5)-2 J gok day
Phone:(_) Email Address: t�A
Email:
(if different than applicant) Legal Description:
2. Parcel No. /% --a IO - (D Q?j 0
Parcel No. - -
3. Purpose of Pre- spection: c-JC i6l 56, 17-' �_ f>&C_
4. Use of building:
5. Do any of the following exist on or adjacent to property?: slope( saltwater( lake( river(p
pond( ) wetland seasonal runoff( other( ) stream( seasonal creek
Directions to Site:
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 develop ent of the site change after the time of inspection.
Applicant Signature: Date: J h
If you would like to be on site during inspection,please check here:
Return application to: Mason County Community Services,Pl 1ng Division
615 W.Alder Street
Shelton,WA 98584
(360)427-9670 ext. 352
Please include a $300.00 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
Rev. April 2021