HomeMy WebLinkAboutOTH Address Requests DEPARTMENT OF COMMUNITY DEVELOPMENT-PLANNING DIVISION
P.O. Box 578, Shelton, WA 98584
Genie Pettit-Addressing, Ext. 291
There is a $5.00 fee for all new addresses issued.
Please allow 5 to 10 working days.
Address Request Form
Name: ��aff-yaf-vt:>
Last First J M.I.
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Current Mailing Address: `-)DY— G3co 9-,__` " Wo,
Street City State Zip
Day 6i Message Phone: P-1) S7 7-69 b'�
Parcel No: 12 13 10--2L?-
Legal Description: �(Qr �m��� & 1-(act5'
Please draw a diagram of your property including nearest existing named road and nearest
existing address. Draw your house and driveway; indicate northerly direction. Please have
your driveway signed or marked for easy identification. All above information is required
to process your request.
FOR OFFICE USE ONLY BELOW THIS LINE
Your New Address Is:
IMPORTANT: Please place, within 60 days, your assigned address number in a
conspicuous location on your structure if visible from the named road; or at the principal
place of access (driveway entrance) if the house is not visible from the named road. This
will allow the most timely service in case of emergency. In addition, please post the
address with the building permit when construction begins on the site.
Received: Issued: Entered: Answered: