HomeMy WebLinkAboutADD2019-00073 - OTH Address Requests - 10/30/2019 MASON COUNTY RECEIVED
COMMUNITY SERVICES APR 1 1 2019
Building,Planning,Environmental Health,Community Health
615 W. Alder Street
Address Request Form/A1212lication
Name: n k f- 'Q/Z y A) Phone: 1-:� 3 5 7�0
Mailing Address: P o Q o x `1
City: `,(/d,KN A State: (VA Zip:��3�5 Prefer:Mail or e-Mail notification to,r><omi
E-Mail Address: VA A,�XOd , C C IV\
Parcel Number: I X 3 30 ` 3 60;L G (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:$185 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.
.................» .•.•....................THIS SECTION IS FOR OFFICIAL USE ONLY....... ».......... ...+..•�.............»»».�..
YOUR NEW ADDRESS IS: I t NT,-- S-�tt-Z- D y-
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RECEIVEVP
6!Eli< TIDEMARK FIRE DISTRICT
BILLEDAID RECEIPT#
Rev.12/27/18