HomeMy WebLinkAboutOTH Address Requests - 5/10/2004 Mason County Permit Assistance Center
Address Request Form
PO Box 186, 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 _ you -a3gs
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Name: Tohn t1. -ESOj)Qi(— Phone: ( )--75'-I'3?�`l tlVf')
Mailing Address: L2 50-1L 851
Street City 05tate Zip
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Parcel Number: 32-t 3 1 /1-j 1_/ 000 10 3k�3
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Legal Description: n 15 E l 1 r1 C,) OC4- M4�
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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 318 1
characteristics (i.e. trailer, brush pile, picnic table). 150
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For official use only below this line
Your New Address Is: 3 33®
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 1"21'O'1 Logged Inv -o�I Tide ark 1U ro Fire District