HomeMy WebLinkAboutADD2019-00174 - OTH Address Requests - 9/11/2019 MASON COUNTY
COMMUNITY SERVICES
• Building,Planning,Environmental Health,Community Health
20
C � i t Address Request Form/Application
Name: (..-olt>q 12A -1-F l-✓1 Phone: C-Cl-
Mailing Address: k 21 t
City. 5.i4-F_-crT State: W N Zip: S 6 r4 Prefer:Mail o e-Mail notification 1 'ire ones
E-Mail Address: el*t k"01& LiVe ,Ccrm
Parcel Number: �2c U- 00 1 (12-digit number)
SITE MAP:PLEASE PROVIDE DRIVING DIRECTIONS TO THE PROPERTY(and most importantly a sketch). SHOW WHICH SIDE OFT E
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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0 Application fee: 1 5 due at time of submittal The Mason County Addressing Ordinance_
0 Make checks payable to:Mason County Treasurer requires you to post your new address
0 Mail application to: within 30 days of assignment.
Mason County Permit Center It must be placed at your driveway entranc
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,
** •*** .* .� + . »..:�..x ,.�,,,. �**THIS SECTION IS FOR OFFICIAL USE
YOUR NEW ADDRESS IS:
RECEIVED LOGGED IN)( TIDEMARK)\/ FIRE DISTRICT
BILLED PAID RECEIPT #
Rev.12/27/18