HomeMy WebLinkAboutOTH Address Requests - 2/28/2005 MASON COUNTY
COMMUNITY SERVICES
Building,Planning,Environmental Health,Community Health
Address Request Form/Application
Name: I-)ANit L FMOC IS Phone: 3360- 6 Z I-A) L9
Mailing Address: 76-8& S EA QfU- HOLLY f-b
City: SC.Afj --0C State: W At Zip: 99380 Prefer:Mail or -M�l notificatio ordcOtte]
E-Mail Address:
Parcel Number: Z2 --'-,037500030 (12-digit number)
SITE MAP:PLEASE PROVIDE DRIVING DIRECTIONS TO THE PROPERTY(and most importantly a sketch).SHOW WHICH SIDE OF THE
ROADWAY YOU WILL BE BUILDING ON IF THE ROAD INTERSECTS YOUR LAND. LIST ANY ADJACENT ADDRESSES YOU ARE AWARE OF AND
NOTATE WHERE YOUR DRIVEWAY IS/WILL BE LOCATED ON THE PARCEL AND NEIGHBORING DRIVEWAYS.
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,4T THE Z.Jj y OF EZDUGNED Z� F W ley SEE A-TTJ4GNE �aL- DETAr-LS
❑ Application fee:$173.50 due at time of submittal The Mason County Addressing Ordinance
❑ Make checks payable to:Mason County Treasurer requires you to post your new address
❑ Mail application to: within 30 days of assignment.
Mason County Permit Center It must be placed at your driveway entrance
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 in a contrasting color,
Addressing questions?Call(360)427-9670 ext. 284 visible from the roadway or driveway.
SECTION IS FOR OFFICIAL USE ONLY***********'******** **•***** *'** '**"»x+*
YOUR NEW ADDRESS IS:
I,L40 nE t3l J4 , L7r Lv E
RECEIVED LOGGED IN rO TIDEMARK FIRE DISTRICT _
BILLED PAID^ E RECEIPT#
Rev.1/27/2017
WJL 9*(Q