HomeMy WebLinkAboutADD2021-00210 - OTH Address Requests - 12/31/2021 MASON COUNTY
COMMUNITY SERVICES
Building,Planning,Environmental Health,Community Health
Address Request Form/Application 6,a1,
Name: on 4" W d(!._r�r -c PCA o Phone:_3_�b 50 l — 6309
Mailing Address: o e J
y: tii '{tip State: )A Zip: y f Cit Pre er Mail or e-Mail notification irY ieonei
E-Mail Address: 2 J
Parcel Number: ec�U // / 'J�o�f (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: 185 due at time of submittal The Mason CountyiAddressing Qrdinanc
Make checks payable to:Mason County Treasurer equi s��you,Eo post your new address
Mail application to:
thi 30lows of assignme
Mason County Permit Center
It must b placed at your drioetvay entranc
Attn: Addressing Division clearly visible feom th ""t" l iri reflective]
615 W. Alder Sty contrastitigmateriai
Shelton, WA 98584 `Address must also be posted to anystruetu
within 30 days of its erection in a contrasting Color,''
Addressing questions? Call(360)427 9670 ext. 365 visible from the roadway or driveway,
SECTION IS FOR OFFICIAL USE ONLY************
YOUR NEW ADDRESS IS: z F_ W�VAt�V
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RECEIVED 1 1 LOGGED IN TIDEMARK FIRE DISTRICT
BILLED PAID RECEIPT#
Rev.12/27/18