HomeMy WebLinkAboutADD2021-00147 - OTH Address Requests - 5/18/2021 MASON COUNTY RECEIVED
COMMUNITY SERVICES rynn�yff
Building,Planning,Environmental Health,Community Health MAY 18 Lt1 L f
Address Request Form/Application 615 W. Alder Sltre t
Name:Jon nn n a 1 ( Phone: 3(o 0 4'1 0. 2-G y
Mailing Address: 1?J H aw-0\ gn -e
City:'O State Zip: Prefer:Mail or -Mail notificatio [Circle One]
E-Mail Address: 2 1LAi► i an'1 cP Cpn'1 CDS f. ne-
Parcel Number: Ili I'Z 1 t(O" U - 5 0 0 2)d (12Zgit 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 County Addressing Ordinance
V191ake checks payable to:Mason County Treasurer requires you to post your new address
ail 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 co or,
Addressing questions?Call(360)427-9670 ext. 365 visible from the roadway or driveway.
SECTION IS FOR OFFICIAL USE
YOUR NEW ADDRESS IS: E Mir&dj- ��6 s -0 ,-
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RECEIVED __ LOGGED IN TIDEMARK FIRE DISTRICT
BILLED PAID RECEIPT # V
Rev.12/27/18
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