HomeMy WebLinkAboutADD2019-00041 - OTH Address Requests - 3/5/2019 ea-
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MASON COUNTY
RECEIVED
rQ I COMMUNITY SERVICES MAR 0 5 2019
Building,Planning,Environmental Health,Community Health `
615 W s`9 y
Address Request Form/Application
Name: Christopher and Hannah Johnson Phone: (310) 903-3786
Mailing Address: 28563 Blythewood Dr
City: Rancho Palos Verdes State: CA Zip: 90275 Prefer:Mail or e-Ma' notification tci,al o,,o
E-Mail Address: Chris L Johnson hotmail.com
Parcel Number: (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 WHEIRE YOUR DRIVEWAY IS/WILL BE LOCATED ON THE PARCEL AND NEIGHBORING DRIVEWAYS.
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❑ 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 98584 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.
SECTION IS FOR OFFICIAL USE ONLY******p*
YOUR NEW ADDRESS IS: ( `I ( E K4a,yhn Na
RECEIVED LOGGED IN TIDEMARK FIRE DISTRICT
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BILLED PAI -00D I RECEI1T#
Rev.1/27/2017