HomeMy WebLinkAboutOTH Address Requests - 3/26/2018r
MASON COUNTY RF
COMMUNITY SERVICES
Building,Planning,Environmental Health,Community Health MAR
Address Request Form/Application 615 IV Aid
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Name: JQSDCI -__MuS Phone: Loa,_
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Mailing Address: 1q1 a
City-,?)e\kx, r State:" Zip: ggsa8 fref r(Mail a-Mail notification tcrck-One)
E-Mail Address:
Parcel Number - (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 LOCH DON THE PARCEL AND NEIGHBO NG DRIVEWAYS.
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❑ Application fee:$173.50 due at time of submittal The N ason County Addressing Ordinance
❑ Make checks payable to:Mason County Treasurer reqi tires you to post your new address
❑ Mail application to: thin 30 days of assignment.
Mason County Permit Center It must a 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.
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YOUR-NEW ADDRESS IS: --- - -- --
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RECEIVED LOGGED IN 0 TIDEMARK C FIRE DISTRICT Z
BILLED PAID-17 S..SO RECEIPT# 5 zo 13 - 'Soo
Rev.1/27/2017