HomeMy WebLinkAboutADD2021-00064 - OTH Address Requests - 12/31/2021 it, :"
2621 -- aoocoL4
F(t N MASON COUNTY
COMMUNITY SERVICES
Building,Planning,Environmental Health,Community Health
Address Request Form/AIDD ication
Name: �)Ia,40A Phone: 3 �D q- O S 9 0
Mailing Address:
City: P()rT Q P'_6j-t O State: Zip: 3 Prefer:Mail or i- ail not' ' tion[Circle on 1
E-Mail Address: y-ay1Ct(5,r\ f %n )-C ;M Sr)
Parcel Number: Z�3 0:3 3 (ion-_�z n (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.
.0' Application fee:=due at time of submittal The Mason County Addressing Ordinance
❑ Make checks payable to:Mason County Treasurer requires you to past your new address
❑ Mail application to: within dam. 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
Addressing questions?Call(360)427-9670 ext. 365 within 30 days of its erection in a contrasting color,
visible from the roadway or driveway.
`*"THIS SECTION IS FOR OFFICIAL USE ONLY
YOUR NEW ADDRESS IS:
5 I I N CAA
RECEIVED LOGGED IN)< TIDEMAR FIRE DISTRICT
BILLED PAID RECE K#
Rev.12/27/18