HomeMy WebLinkAboutSPI2004-00178 - SPI Application - 6/5/2004 i
MASON COUNTY --el:uOH-00I1
PLANNING DEPT. PRE-INSPECTION APPLICATION
PLEASE PRINT $205.00 Fee Required
1. Owner: rtaaE7w emu) Applicant: Lgr.T ,A 8� q
Site Address: imo mF-mousbN1 9wrs.gL17,fL Applicant Address: ics43 L((J-yts,-, i�Srt.,L,)
Owner Address: 3sz-4 So,-ru 6 s,. City: (-,,& St-Lu-,4—, Zip 9B-3z.-I
City:'TAW,,1 A. St_JA)A Zip 9$32 i Phone:_(ZS3 ) �-�f qI s� day
Phone:_(?�3 ) Lf 7(, -3 Z&,p, day Phone:_(7s3 evening
2. Parcel No. ZZ369r - 7-7 - 1)(*)32.n
Parcel No. zz3o 9 - 7-1 -_903( t Email Address: 4
Legal Description: 3Z oP Surw 13/Zzy ; Planner: GBM RAM DMJ SAL TSC
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Type of Us
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3. Purpose of Pre-Inspennction :
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4. Use of Building:&Je uliad MnAg nod
5. Do any of the following exist on or adjacent to property?: slope (!) saltwater ( ) lake ( ) river ( )
pond (,-) wetland ( ) seasonal runoff ( ) other ( ) stream ( ) seasonal creek
Directions to Site: r rzo NA -
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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
Applicant Signature: Date /dSL)y
IV/
If you would like to be on site during inspection, please check here: (✓)
Return application to: Department of Community Development, Planning Division
P.O. Box 279
Shelton, WA 98584
(360)427-9670
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:
Please illustrate below the proposed building site in relation to water&property lines:
SRG/Word/MyOo mems/TypedSMf/Preinspection MORE ON BACK SIDE
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:
Revised 12-26-2003 SRG
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