HomeMy WebLinkAboutADD-02 - OTH Address Requests - 10/29/2002 e
Mason County Permit Assistance Center
Address Request Form
P.O. Box 578, Shelton, WA 98584
Genie McFarland, Addresser, (360)427-9670, ext. 291
There is a $15.00 fee for all new addresses issued.
Please allow 5 to 10 working days for processing
Name:_ L�T1 ��s_ 16wn5,e_M Phone:( L )_��'7 -�j(�7� X 1400
Mailing Address: 1a E_ - �z p -tc4 G�85r�q
Street City State Zip
Parcel Number: / / GCXA p
Legal Description: j p,'Q -2
Please draw a diagram of your property including the nearest existing county-or
private road and nearest existing address. Keep in mind that we physically visit
most sites. Your proposed driveway must be clearly marked. Please note any
h sical characteristics i.e. trailer, brush pile, picnic table.
FOR OFFICIAL USE ONLY BELOW THIS LINE
Your New Address Is: Cj 6 S (t 0 E
6— 1�65 Ed -
Important: Please place, within 60 days, your assigned address number at your
driveway location and on your structure. This will allow the most timely service in
case of emergency. In addition, please post the address with the building permit
when construction begins on the site.
Received D-Z`-o Logged In Ai--Ai -Z`1-CZFire bistrict I te