HomeMy WebLinkAboutMIS94-00179 Pre-Inspection - MIS Application - 4/13/1994 MIS 7 r
MASON COUNTY
PRE-INSPECTION APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 • 427-9670
$25.00 Fee Required prior to inspection
PLEASE PRINT L/#1 Owner � /L,` /k/4 L>�/ Al Phone # 7 2- /-7
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Site Address 0/0 X zA,,7 4) City S-iS�C/Tui+/
Mail Address
City St Zip
Applicant /V/C f,/.9 E T/i Phone # yZ G — 5W G 2- `>
Applicant Address , SG q-"/ET RQ
City __:�'W"zy%n
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#2 Parcel No. ✓�� ` - ,��G ICJ�J
Legal Description
#3 Purpose of Pre-Inspection /h % 2 �►'7/�i� /),c %v 6 /i
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#4 Use of building (��✓f� /� I�'",(� /�i5i ���-�C��,S%talc"
#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: /L,� A ,Q 7v T�'����"�
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 y !- �d1_ Date
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FOR OFFICIAL USE ONLY: Accepted by: Date: '�L
Receipt No. _ Referred To
DEPARTMENTAL REVIEW
FOR OFFICIAL USE ONLY
Proposal Proposal
Approved Denied
Planning:
Building:
Fire Marshal:
Special Conditions