Fillable SITE ADDRESS APPLICATION (Lewis County)

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SITE ADDRESS APPLICATION (Lewis County)

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Lewis County Community Development
2025 NE Kresky Ave, Chehalis, WA 98532 ● Phone: (360) 740-1146 ● Fax: (360) 740-1245
S:\COMMUNITY DEVELOPMENT\Applications & Forms Updated November 2020
SITE ADDRESS APPLICATION
Property Information:
Tax Parcel Number: Owner’s Name:
Phone Number: Email:
Owner’s Mailing Address:
Applicant’s Information:
Name: Phone Number:
Mailing Address: Email:
Submit a complete application packet to the Permit Center at the address listed above. Incomplete applications
will not be processed. A sample site map is attached. The following is required for submittal:
Completed site address application
Detailed site map (parcel/aerial map) showing:
The nearest County or State Roads
Neighboring properties and addresses
Locations of the driveway / private road from the County road to the parcel
Site Information:
Road Name: ☐ Private Rd ☐ County Rd ☐ State Hwy
Address of nearest neighbor: Is there an existing driveway? ☐ Yes ☐ No
For Official Use Only:
Application Type
☐ New Address ☐ Change of Address ☐ Secondary Address ☐ Verification
Permit Tech: Date Received: Application Number:
Road Approach Permit: ☐ Existing approach ☐ New Approach Required
Address Assigned: City:
S:\COMMUNITY DEVELOPMENT\Applications & Forms
Updated November 2017
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SITE ADDRESS APPLICATION (Lewis County)

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Completed 21 January 2021

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