HomeMy WebLinkAboutOTH Address Requests - 12/31/1993 MASON COUNTY
COMMUNITY SERVICES
Building,Planning,Environmental Health,Community Health
Address Request Form/Application
Name: p caav 3 Y'a to e — v-ncict'vo Phone: 3 G O—SO l—O.j 0 I
Mailing Address: MA 11 ZZ G nar0yi env Ave
City:_'::�W_1 t0 n State: W A Zip:CN594Y_ Prefer•:Mail or e-Mail notification iciae One]
E-Mail Address: CAc 0'r U c. 93 @ qM G; I. C o►n
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Parcel Number: oZo�D3D 9-1b 000�)G (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.
❑ Application fee: $173.50 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 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 985&4 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. 284 visible from the roadway or driveway.
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RECEIVED D LOGGED IN� TIDEMARK FIRE DISTRICT
BILLED PAID RECEI #
Rev.1/27/2017