HomeMy WebLinkAboutADD2020-00030 - OTH Address Requests - 2/19/2020 Lid Ic
MASON COUNTY FLb) 1
COMMUNITY SERVICES
Building,Planning,Environmental Health,Community Health
Address Request Form/Application
Name: 'Rny t� a --. �, �A Phone: A
Mailing Address: jR61 Lko 4jb A,A'Z_ mil ,
City: S`H6F4 �j ®A1 State: Zi
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E-Mail Address: ti�� _ ' /�r ��t--f�C � r=��/'y;-- �9�,� --Dad� i
Parcel Number: �2 /- -3 - 5'bol) (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
*4J 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
❑ Make checks payable to:Mason County Treasurer requires you to post your new address
❑ Mail application to within 30 dam of assignment.
Mason County Permit Center It must be placed at your driveway entrance
Attn:Addressing Division clearly visible from the road iri 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. 365 visible from the roadway or driveway.
SECTION IS FOR OFFICIAL USE
YOUR NEW ADDRESS IS:
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RECEIVED LOGGED IN�( TIDEMARK' FIRE DISTRICT
BILLED PAID RECEIPT#
Rev.12/27/18