HomeMy WebLinkAboutOTH Address Requests MASON COUNTY
" CO& COMMUNITY SERVICES DEPARTMENT
ADDRESSING DIVISION
615 W. ALDER ST. SHELTON, WA 98584
(360) 427-9670 ext. 284
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Address Request Form
******* $173.50 Fee
NAME: ��C( ►'J B t PHONE:otiO t 112
MAILING ADDRESS: I? �'R S G CITY: u'Y STATE: .ZIP:
E-MAIL ADDRESS: `('QCt l Q 5 1 °t -P S C 6W"
PARCEL NUMBER: 3 3 0 — 5 3 - od O 4— (twelve digit number)
LEGAL DESCRIPTION: Lcs m —2 `>~
PLEASE PROVIDE DRIVING DIRECTIONS TO THE PROPERTY.WHICH SIDE OF THE ROADWAY YOU WILL BE B ILDING ON IF THE
ROAD INTERSECTS YO R LAND.ANY ADJACENT ADDRESS YOU ARE AWARE OF AND SIMPLE DIAGRAM OF WHERE YOUR
f DRIVEWAY WILL BE LOCATED ON THE PARCEL.
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he Mason County Addressing Ordinance requires you to post your new
address within 30 days of assignment.
It must be placed at your driveway entrance clearly visible from the road in reflective contrasting material.It must be posted to
any structure with 30 days of its erection in a contrasting color,visible from the roadway or driveway.
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YOUR NEW ADDRESS IS:
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RECEIVED LOGGED IN,,/ TIDEMARK FIRE DISTRICT
BILLED PAID ' RECEIPT# '
REV. Nov 2016 ADDRESS REQUEST FORM FILLABLE-ALDER.doc