HomeMy WebLinkAboutPre-Inspection Foundation and Block Wall - MIS Inspections - 1/30/1995 MIS
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
#1 Owner T �}� i��R�4 Q Phone#
Site Address n 4y'-f13oa/ C ,4tiC- City 5ACC710 ✓
Mail Address
City St Zip
Applicant Phone#
Applicant Address
City St Zip
#2 Parcel No. r
Legal Description
#3 Purpose of Pre-Inspection -7`.4/3G'Fc Fy/57-/A/4 r"rC'*4 fie A✓
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#4 Use of building 9,MP !�wV,r A 4
#5 Indicate by circling the applicable source if any water is on or adjacent to subject property:
saltwater lak creek stream marsh river pond wetland seasonal runoff other
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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 Dom. ,
ALUQntdbFCROFtCI yY date:
Receipt No. Referred To
DEPARTMENTAL REVIEW
FOR OFFICIAL USE ONLY
Proposal Proposal
Approved Denied
Planning:
Building:
Fire Marshal:
Special Conditions
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