HomeMy WebLinkAboutADD2023-00080 - OTH Address Requests - 4/5/2023 MASON COUNTY
• COMMUNITY SERVICES
Building,Planning,Environmental Health,Community Health
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Address Request Form/Application
Name: i��'A , Phone:,lr5�9�`7!�7-
Mailing Address -el/j 2 N: AJ2?r r-eel J? /- ry
City: 1 e- State:& Zip: % d I6 Prefer:Mail a Mai notification[arde onrj
E-Mail Address: r 0 eG, C O W1
Parcel Number: —,an dI. (12-digit number)
SITE MAP:P PROVIDE DRIVING DIRECTIONS TO THE PROPERTY(and most importantly a sketch).SHOW WHICH SIDE OF THE
ROADWAY YOU W%L BE BUILDING ON IF THE ROAD INTERSECTS YOUR LAND.LIST ANY ADJACENT ADDRESSES YOU ARE AWARE OF AND
NO WHERE YOUR DRIVEWAY IS/WILL BE LOCATED ON THE PARCEL AND NEIGHBORING DRIVEWAYS.
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❑ Applica on fee: 85 due at tune of submittal The`Misoni.County Addressing Ordinance
ElMake ch c ks payable to:Mason County Treasurer re''uires.yoU.to.post your aew address
❑ Mail app 'cation to �!ithin'30 days:of.assigititient:.
Mason County Permit Center It must be placed at your driveway entrance:':':R
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 w:a.cont:rasting color,
Addressing uestions?Call(360)427-9670 ext. 365 visible from thew.. ..y or driveway..
»+t»»»+»+»»+»»»+»++ +»*»»»»»»»»»»»»»»»+»+THIS SECTION IS FOR OFFICIAL USE ONLY**»****+*****+»++»+»»»»»»+»»»»»»»+»»+»»+»»»»»+»+
YOUR NEW 4 DRESS IS:
VV q 1A
RECEIVED LOGGED IN r TIDEMARK rD FIRE DISTRICT
BI ED PAID RECEIPT#
Rev.12/27/18
Pr'MtONdirom