HomeMy WebLinkAboutOTH Address Requests 4W Mason County Permit Assistance Center
Address Request Form
P.O. Box 578, Shelton WA 98584
Genie Mcfarland, Addresser, (360) 427-9670 ext. 291
There is a $140.00 fee for all new addresses issued.
Please allow 5 to 10 working days for processing
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Name: a'r 1 Phone: (�1e6 )may/
Mailing Address: A?S`� �
Street City State Zip
Parcel Number: 1,2 330 /_S y / OM
Legal Description: 'Ou.- 0 3e,.rI 'Lj&6te_ Mo -,Tin41 reCbrcit-�
Please draw a diagram of your property including the nearest existing county or
private road and nearest existing address. Keep in mind that we physically visit most
sites. Your proposed driveway must be clealry marked. Please note any physical
characteristics (i.e. trailer, brush pile, picnic table).
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For official use only below this line
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Your New Address Is:
Important: Please place, within 60 days, your assigned address number at your
driveway location and on your structure. 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 Logged In Tidemark Fire District