HomeMy WebLinkAboutOTH Address Requests - 12/13/2017 MASON COUNTY RECEIVED
0 Q)I COMMUNITY SERVICES
DEC 13 2011
Building,Planning,Environmental Health,Community Health
615 W. Alder Str et
pp Address Request Form/Alication
Name: KCA Y 1 —t �?O ZAD - _(C Phone:SV10 D-7 S ?G J
Mailing Address: as,6 YA Q
City: Jl State::� Zip: �OS Z.Prefer:Mail of a-Mai otification rciraeo.a
E-Mail Address: m m P65-P\.e� 1'n`e• corn
Parcel Number: `Z-5 Z LT- 7 J q 0(3 Ll( J (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.
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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.
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YOUR NEW ADDRESS IS:
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RECEIVED LOGGED IN TIDEMARK- FIRE DISTRICT �L
BILLED PAID RECEIPT# $31411-�O�fa'I
Rev.1/27/2017
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