HomeMy WebLinkAboutSPI2005-00064 - SPI Application - 3/3/2005 Qcx)Ct)- c)odcol
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MASON COUNTY
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PLANKING DEPT. PRE-INSPECTION APPLICATION
PLEASE PRINT �— $205.00 Fee Required
1. Owner: 4A/I ;e fit`t G Applicant: sAA..e
Site Address: a _ Applicant Address:
Owner Address: P o. a City: St Zip
City: a St ZA2,L-Zip g j 3 Phone:_( ) day
Phone:_(Z EU Z Z G _ y Z,Z y day Phone:_) evening
2. Parcel No. ,3 2./ "L
Parcel No. - - Email Address:
Le?l Description: Za / Planner:
SMP Comp.Plan Type of Use
Water Body
3. Purpose of Pre-Inspection �L /Ve_51 141,4 k IZ� S'z. Lip
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4. Use of Building: -S.42rZt
5. Do any of the following exist on or adjacent to property?: slope(k) saltwater lake river fi
pond wetland( seasonal runoff( ) other ) stream 04) seasonal creek lr
Directions to Site: 5,,�/e/�a,�, � /✓,rtJ Ste,✓ , T,p,�Y Zrcv
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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:
Date:
If you would like to be on site during inspection,please check re:
Return application to: Department of Community Development,Planning Division
P.O.Box 279
Shelton,WA 98584
(360)427-9670 \`J
Please include a$205.00 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:
ORE ON BACK SIDE
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I:\PLANNING\CHARELL&RENEE\PRF,-INSPECTION Revised: 11/15/04
Please illustrate below the proposed building site in relation to water and property lines:
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Departmental Review
(For Office Use Only)
Planning Department Findings:
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I:\PLANNING\CHARELL&RENEE\PRE-INSPECTION Revised: 11/15/04