HomeMy WebLinkAboutOTH Address Requests - 11/1/2018 MASON COUNTY 6 1. ` op
`
• COMMUNITY SERVICES �M
Building,Planning,Environmental Health,Community Health
Address Request Form/ARRlication
Name: 411 L") �( kq l_.-' a S. Phone:(G 2 C j ' 2 - 7 eJ
Mailing Address: 1/3 C Ac f f
City: 1 State: 6-M Zip: f�F(O � Prefer:Mail r e-Mail n tification rcir��e ej
E-Mail Address:
Parcel Number: 2 - �'c'' �� (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 AN
NOTATE WHERE YOUR DRIVEWAY IS/WILL BE LOCATED ON THE PARCEL AND NEIGHBORING DRIVEWAYS.
1 C/
A ,r ( ( v ('e 5
cv
❑ Application fee: 173.50 due at time of submittal T1 a Mas€n C+ uoty Addres$i�ni Cl c i Lance
❑ Make checks payable to:Mason County Treasurer ourniw
❑ Mail application to: itiln 0 t of asssppsent.
Mason County Permit Center Ius
t Pled ate°dx' e *ay e ,
Attn: Addressing Division 'Iear
IY r f ? I refl v
615 W. Alder St �ont=asting
Shelton,WA 98584 Ai:I+Ixe s must.also be po d to.a any oftucture,
Within 3p days cif its*' i+E o rt a ct rast>Il g cta ,;
Addressing questions?Call(360)427-9670 ext. 284 i i e a " ,roa
THIS wayof
SECTION IS FOR OFFICIAL USE ONLY
YOUR NEW ADDRESS IS: �
RECEIVED: LOGGED IN TIDEMARK FIRE DISTRICT
BILLED -- PAID✓'1'j. RECEIPT#
Rev.1/27/2017