HomeMy WebLinkAboutOTH Address Requests - 3/26/2018 REcEIV
MASON COUNTY ED
COMMUNITY SERVICES MAR
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Building,Planning,Environmental Health,Community Health O'S
er Strye
Address Re
quest e uest Form/Application t
Name:V& JaQ�nyw e, =f� g S Phone: �(D()-0(oG—0 7 Lo D
Mailing Address: Q• \^cn
City-bZ�1Q�( State:UQ_ Zip:CM SQS Prefer _ ail r e-Mail notification tci.,ieo,ei
E-Mail Address:
Parcel Number M y 6 q� q f� (�� (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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❑ Application fee:$173.50 due at time of submittal The Mason County Addressing Oxd*ce
❑ Make checks payable to:Mason County Treasurer requires you to post your new addrri� I
❑ Mail application to: within 30 days of assignment. r1'l
Mason County Permit Center It must be placed at your driveway entrice V
Attn: Addressing Division clearly visible from the road in reflective r
615 W. Alder St contrasting material. T
Shelton, WA 98584 Address must also be posted to any strUture
within 30 days of its erection in a contrasting color,
Addressing questions?Call(360)427-9670 ext. 284 visible from the roadway or driveway.
�**.,.»»rt **" THIS SECTION IS FOR OFFICIAL USE
- YOUR NEW ADDRESS-I-S: - _ --- -
RECEIVED LOGGED IN G TIDEMARK G FIRE DISTRICT 2'•
BILLED PAID 1_73•50 RECEIPT# 5310 11
Rev.1/27/2017