HomeMy WebLinkAboutADD - OTH Address Requests - 6/26/1997 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.
Address Request Form
Name: V"l ctt �'__1
Las i t First M.I.
Current Mailing Address: °Z4ORg 1��1 5�� QL i_-c 1 6S03
Street City State Zip
Day or Message Phone: (N,,O) '12,-7 — oGS'.;—
Parcel No: 5y/, /l /�- L2 - /o/o/i /.�2_
Legal Description: Lof a old 54o,4 1040f iU�.o?7!/ 2,ecoa ded orr Ha o?%_/99Gt �,✓
1/4 14 101 Itt2 l k 19 e e of
Or SQC r L/ ZCJ X4, 17 (5*"4�If
Trz.l b O F I To- o 5t 44-- �.
Please draw a iagram of your property including n crest 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.
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'''' IlFOR OFFICE USE ONLY BELOW THUS LINE
Your New Address Is: l�l� p1 dL
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.
Received: Issued: Entered: Answered: 1_0 0(v 7 ``Q