HomeMy WebLinkAboutOTH Address Requests - 12/4/2018 f �
MASON COUNTY RECEIVED
COMMUNITY SERVICES DEC 0 4 2018
Building,Planning,Environmental Health,Community Health
615 W.Aider Street
Address Request Form/Application
Name: - Phone:
Mailing Address: �� �3J ti LTV 1 ()
City: State: WAip:q9j0 Z_3 Prefer:Mail or -Mail notification _L� One]
E-Mail Address: r ri�4 1'y-)
Parcel Number: 1_2;2� 8 b D C o (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 WHERE YOUR DRIVEWAY IS/WILL BE LOCATED ON THE PARCEL AND NEIGHBORING DRIVEWAYS.
-4fi_e , k4w 13) N
I.c)_al &?-? fj'_ . ')
g , U_')A4_0Q"r2_
s7L
❑ 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. 365 visible from the roadway or driveway.
....ssrxs:sssass»ss::assss:sssstss***.**ssT'HIS SECTION IS FOR OFFICIAL USE ONLY������s�sssssssssrss*sraws*»saa+sssssssxssasssss
YOUR NEW ADDRESS IS: ')<Z/ I F r�/�►�t
RECEIVED LOGGED IN TIDEMARK FIRE DISTRICT
BILLED PAID CAN�(_ ,L REC PT#
Rev_1/27/2017
V
j
t-or low
SURVEY FOR a
&V"
/rar,E
,�,C,y. //, B•G�S�-9 �C/l. :'.2, ,�3,C�YflltOfl,y�/F1t��'YCO/!'ll�O,l �//f///,�'
r'rYE�O/?/I�OFf,'.G.CY.'Y. ,y�CriOsr s�.00iy.%�r�/�'o.�,sEcrivr�'�•o,
!-O.�r�✓rS�/�dZ�O��r�; /�•�n'6.E1h'�rFa/�ac�l�l�'�1/iY/�C i�Y.c�
,c90U/!O,9�Y OF�'y.�`','0I!'/YOf.S�LlYil;
SURVEYOR'S CERTIFICATE
THIS MAP CORRECTLY REPRESENTS A SURVEY
MADE BY ME OR UNDER MY DIRECTION IN THORNTON LAND
CONFORMANCE WITH THE REQUIREMENTS OF �`���°`
Tur giiovav RcrnaniNr Ar.T AT THE REOUEST /ter ,��± '�'y� PO. Box 249