HomeMy WebLinkAbout2 Addr - OTH Address Requests - 11/21/2017 MASON COUNTY RF
COMMUNITY SERVICES CS/V&
Building,Planning,Environmental Health,Community Health No D
Address Request Form/Application Qta W
Name: , I/1C9--1' I N 1 C�/1C� f 5 Phone: lob 0 - lQ r
Mailing Address: I Cl
City: '�)V1-Q_-(4,-!2>' I State: U44 Zip: S�q Prefer:Mail a-Mail no ' -cation iciraeo„ei
E-Mail Address: C LdsLrI I bAzO--v'c�. 0,(��J' COL✓1 �-
Parcel Number: 3 Z 0 q (12-digit number)
SITE MAP:PLEASE PROVIDE DRIVING DIRECTIONS TO THE PROPERTY(and most importantly a sketch).SHOW WHICH SIDE OF THE
ROADWAY YOU WILL BE BUILDING ON IF THE ROAD INTERSECTS YOUR LAND. LIST ANY ADJACENT ADDRESSES YOU ARE AWARE OF AND
NOTATE WHERE YOUR DRIVEWAY IS/WILL BE LOCATED ON THE PARCEL AND NEIGHBORING DRIVEWAYS.
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❑ Application fee:$173.50 due t time of submittal The Mason County Addressing Ordinance
❑ Make checks payable to:Mn un Treasurer requires you to post your new address
❑ Mail application to: I ps within 30 days of assignment.
Mason Coun Center It must be placed at your driveway entrance
Attn:Addressing Division clearly visible from the road in reflective
615 W.Alder St contrasting material.
Shelton,WA 98584 Address must also be posted to any structure
within 30 days of its erection in a contrasting color,
Addressing questions?Call(360)427-9670 ext. 284 visible from the roadway or driveway.
ss*»ssrwrss:srsrrrrxrrtsrssrrswrs: risr*'*THIS SECTION IS FOR OFFICIAL USE ONLY:rwx:srrr:•»:.sst:w+rss»r♦s»ssxsxr�rsswsrr:r»s»»x
YOUR NEW ADDRESS IS:
1 6'l 5 E ?QL.6i zr M 6-Y10 i2 L,(�' E
6 h cOo n W-A c 2),55844
RECEIVED LOGGED INZ' TIDEMARK FIREDISTRICT
BILLED PAID In 50 RECEIPT#4S 3 GO 1.7 -607e5
Rev.1/27/2017