HomeMy WebLinkAboutADD2019-00006 - OTH Address Requests - 1/19/2019 MASON COUNTY ✓ F�
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COMMUNITY SERVICES esw 9 <70,9
Building,Planning,Environmental Health,Community Health A'_,
AA&ess Rgqu est Form/Application er Street
Name: Jeremy Fukien Phone: 253-509-2581 1
Mailing Address: 1171$ 36th ava Ct nw
Icky: Gig Harbor State, k Zip 98882 Prefer.Mail or -Mafi otificationta.*o,.t
Address: ieremyfoldenacomcast_net
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 ANYAD?ACENT ADDRESSES YOU ARE AWARE OF AND
NOTATE WHERE YOUR DRIVEWAY IS/WILL BE LCXAMD ON THE PARCEL D NEIGHBORING DRIVEWAYS.
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01 A placation fee: 18 due at time of submittal The Mason County Addressing Ordinance
13 Make checks payable to:Masm County Treasurer quii6�you to postydUk new addtt§s
0 Mail application to: wi in 30 days of,went.
Mason County Permit Center It muo he placed aty~ veway e'er
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 427-9670 ext. 365 vile from the roadway or driveway.
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YOUR NEW ADDRESS IS: ` y k 1c,
RECEIVE
- LOGGED IN TIDEMARK FIRE DISTRICT
BILLED_ PAID l S .041 RECEIPT# ZO IA-O -74
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