HomeMy WebLinkAboutPre-Inspection Espresso Stand - MIS Application - 3/22/1998 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 S NEI L-fi JR bCiQ/A1,Thone#
Site Address City
Mail Address p5,Z_ 0- CoYryy\.o k-TJ GL.u.Cv
City L_7rD n_ St Zip
Applicant e_ E i K Phone#
Applicant Address
City St Zip
#2 Parcel No. - -
Legal Description
#3 Purpose of Pre-Inspection oil 1 KLG —F)u 11_J71 N (Z B uLa I M F,sS 'r2�
#4 Use of building >=��Q.ES-r'a .-�Rt� Tyr R.4�— W
#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 sea2!1 al Yunoff other 1\b
Directions to Site: S O U) L
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.
Applicant Signature Date
J
FOR OFFICIAL USE ONLY: Accepted by: t dale
Receipt No. #' rred To
DEPARTMENTAL REVIEW
FOR OFFICIAL USE ONLY
Proposal Proposal
Approved Denied
Planning:
Building:
Fire Marshal:
Special Conditions
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