HomeMy WebLinkAboutOTH Address Requests - 3/5/2007 j,'(-)0(A
Mason County Permit Assistance Center
14;
Address Request Form
PO Box 186, Shelton WA 98584 �
Brenda Jantz, Addresser, (360) 427-9670 ext. 291
There is a $154.00 fee for all new addresses issued
Please allow 5 to 10 working days for processing
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Name: RICHARD DICKINSON Phone: 360-520-7378
Mailing Address: 6321 NEYLON DR SW OLYMPIA WA 98512
Street City State Zip
Parcel Number: 321331090013
Legal Description: LOT: 3 OF SP #2269 PTN TR 1 OF NE
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).
For official use only below this line
Your New Address Is: r " t C�30V LL'Ve lza
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Important: cCBS"gq
Please post the address with the building permit when construction begins on the site.
Emergency services request you please place, within 60 days,your assigned address number at your driveway entrance and on your
structure.
Received 2/28/07 Logged In J Tidemark Fire District