HomeMy WebLinkAboutADD2019-00002 - OTH Address Requests MASON COUNTY
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COMMUNITY SERVICES
Plann
ing,�Environmental Health,Community Health
Address Request Form/Application
Name: Phone:
Mailing Address: L kc, k
City: C e, Rio State: Zip: Prefer.Mail ir e-Mail n tification ic.=L�One]
E-Mail Address:
LAf_Parcel Number: AMS- W M _-�:4 C MV CW J% (12-digit number)
W�21 '51 D I-- 2.:'1-
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.
CID
El Application fee:8173.50 due at time of submittal The Mason County Addressing Ordinance
El Make checks payable to:Mason Countynew address
Treasurer requires you to post your
13 Mail application to: Within 30 days of assignment.
Mason County Permit 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 cit. 284 visible from the roadway or driveway.
..TMS SECTION IS FOR OFFICLAL USE ONL-y***.** ...
A OU R_NE W_ADDRESS J S,—
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RECEIVED D 1 LOGGED I $TI EMAR FIRE DISTRICT
BILLED PAID RECEIPT#7�
Rev.1/277/2017