HomeMy WebLinkAboutOTH Address Requests - 2/15/2007 11 C6C'6L 4
Mason County Permit Assistance Center
goEl _ Address Request Form
PO Box 186, Shelton WA 98584
Brenda Jantz, Addresser, (360) 427-9670 ext. 291
There is a $I40.00 fee for a//new addresses issued
Please allow 5 to 10 working days for processing
. ... .. ... ... ... ...... ....................... . . ..................... ...... .......
Name: lele5 Phone: ( �6(- ) Y7-7493-y
Mailing Address: S4el1, le L,e
Street City State Zip
Parcel Number: 3 / 00 / OD 2 Z
Legal Description: Z 5,54# S%z t'Yz 33.- Z i —3
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
Your New Address Is: 23W M c-Ewc.li ?rc,; V' j e,
Important. Please post the address with the building permit when construction begins
on the site.
Emergency services request you please p/ace, within 60 days, your assigned address
number at your driveway entrance and on your structure.
Received < ' ? Logged In - _ Tidemark 2_l =i 7 Fire District_
PD Billed Case Bill