HomeMy WebLinkAboutBLD2008-00628 Pre-Inspection - BLD Application - 5/28/2008 MASON COUNTY
PRE-INSPECTION APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 • 360-427-9670
$68.00 Fee Required prior to Inspection
PLEASE PRINT
#1. Owner w.tN S-1 _ ,f4.,�..�.��.o� Daytime Phone # y>>- '11d- y;1'3
Site Address 1 f. 0 �� �,���.�. a. City3-QAg..
Mail Address
City ��\G -J��� St W Zip ck ko u
Applicant
Applicant Addre s
City ��c��1� �I cc.��r a St W A Zip `t o
#2. Parcel No. 3 I al 00
Legal Description
#3. Purpose of Pre-Inspection
#4. Use of Building 5
#5. Indicate by checking the applicable source if any water is on or adjacent to subject property:
• Saltwater • Lake Stream Marsh • River • Pond • Wetland • Seasonal Runoff• Other
Directions to Site: 11 DEAL p S. S \0 L"'t .ArY N ate:... l�•�•.�
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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 & Frontage Streets. Indicate
directional by N, S, E W, etc.
Alk-kel 23,-6 s. .{�ov o ✓� '
0 5 6.
Applicant Signiture Date S' 6 (A
DEPARTMENTAL REVIEW
FOR OFFICIAL USE ONLY Proposal Proposal
Approved Denied
Planning:
Building:
Fire Marshal:
Special Conditions