HomeMy WebLinkAboutPre-Inspection - SPI Application - 9/24/1986 BLD
MASON COUNTY
PRE-INSPECTION APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 • 360-427-9670
$58.00 Fee Required prior to Inspection
PLEASE PRINT
#1. Owner Daytime Phone #
Site Address City
Mail Address
City St Zip
Applicant
Applicant Address
City St Zip
#2. Parcel No. O
Legal Description !,t'VZ1r
#3. Pu ose of Pre-Inspection 1 /7 `{yl Q
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#4. Use of Building
#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:
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.
Applicant Signiture Date
FOR OFFICIAL USE ONLY: Accepted by.f
Receipt No. Referred To:
DEPARTMENTAL REVIEW
FOR OFFICIAL USE ONLY Proposal Proposal
Approved Denied
Planning:
Building:
Fire Marshal:
Special Conditions