Rev. 12/27/18
Address Request Form/Application
Name: _________________________________________________________ Phone:_______________________________
Mailing Address: _____________________________________________________________________________________
City: ________________________________ State: ______ Zip: ___________ Prefer: Mail or e-Mail notification [Circle 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 LOCATED ON THE PARCEL AND NEIGHBORING DRIVEWAYS.
Application fee: $185 due at time of submittal
Make checks payable to: Mason County Treasurer
Mail application to:
Mason County Permit Center
Attn: Addressing Division
615 W. Alder St
Shelton, WA 98584
Addressing questions? Call (360) 427-9670 ext. 365
The Mason County Addressing Ordinance
requires you to post your new address
within 30 days of assignment.
It must be placed at your driveway entrance
clearly visible from the road in reflective
contrasting material.
Address must also be posted to any structure
within 30 days of its erection in a contrasting color,
visible from the roadway or driveway.
*******************************************THIS SECTION IS FOR OFFICIAL USE ONLY************************************************
YOUR NEW ADDRESS IS:
RECEIVED LOGGED IN TIDEMARK FIRE DISTRICT __________
BILLED___________ PAID______________ RECEIPT # ____________________________
