HomeMy WebLinkAboutADD-96 - OTH Address Requests - 10/2/1996 DEPARTMENT OF COMMUNITY DEVELOPMENT-PLANNING DIVISION
P.O. Box 578, Shelton, WA 98584
Genie Pettit-Addressing, Ext. 291
There is a $5.00 fee for all new addresses issued.
Please allow 5 to 10 working days.
RECEIVE6
Address Request Form SEP261996
MASON CO. D01
Name: W n a U d —�
Last First M.I.
Current Mailing Address: _ 70 S _ �E v vrc Lc— �� vd Ske-1 f�,n ,�? `)1? S� y
Street City State zip
;X C�
Day or Message Phone: S ( cxor14 S
Parcel No: /O/O/R 7
Legal Description: =�� I I Q oP S1�o�-F �'; i�d � ; t ;rn� 2.3� ( �20 rk%oh 04�
_I7A 1 V c f�tP.r.S -1- r.4�r{�t^ N '�-1� e 'f-f.o (�l o�"{{,.�«S+• U uc�-i^f.�r- y�jE `I`-t
0�p 'S C?C* O'•1 Noy: iZc e_ -P-o tc r- C14)
Please draw a diagram of your property including nearest existing named road and nearest existing
address. Draw your house and driveway; indicate northerly direction. Please have your driveway signed
or marked for easy identification. All above information is required to process your request.
F � 8'
FOR OFFICE USE ONLY BELOW THIS LINE
Your New Address Is: U10 EICI L40yid buu1
IMPORTANT: Please place, within 60 days, your assigned address number in a conspicuous location
on your structure if visible from the named road; or at the principal place of access (driveway entrance)
if the house is not visible from the named road. 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.
L bV_K_ Received: j!) q• Issued: 10 .)-9ra Entered: a..L1(P Answered: