HomeMy WebLinkAboutADR2009-00145 V
1�1,A0q_ lla ADDRESS REQUEST RECEIVED
ED
.D 09-i Q4-JEFFERSON COUNTY PERMIT CENTER
621 Sheridan, Port Townsend,WA 98368 (360) 379-4450 APR _ P ?ring
APPLICANT: Please fill out item 1 through 8. Fee as per Jefferson County Fee Schedule
1.XNew Address n Correction ❑ Change EReview DIFF LEFT JFFrsm k ' HT:',: DIFF
alb.-fl 11: 4.
2. Applicant Name: IA_QY�.Cy C , O0� 1/4c`s€_v
3. Mailing Address: 4-2-LE 1 ( I( St. .4±. ��-
Town/ State/Zip ?Q C`t TO W h-S£1`‘4 !019
4. Telephone: Work — Home:03(43)3 7c)_OA,
5. Location: Attach a Detailed Drawing or Map.
Additional Fees May Be Required if More Than One
Site Visit Is Necessary
*******PLEASE FLAG YOUR DRIVEWAY.*******
Date Flagged: 3/15,O Flagging Color r
Nine Digit Tax Parcel Number 9 O 1—3 6 — O O 1
Plat Name Block Lot
6. Road Name: E r\ 4*"' ‘;`,-Z+
Is this a PRIVATE o UNTY oad? CIRCLE ONE
Nearest Cross Road: O d E cKsp.vy,cWhV -c, •
7. Neighbors' Address if Known: JJ 1
Name/Address: J g ' C rr` c i f o, eNer,pu k�tYK
Name/AddressR'eke c .rthecto1/4,1 I (p� �l}e 60
°
8. Do You Need To Construct a Driveway?
YES or. NO CIRCLE ONE
FIELD NOTES
9 This Submitted With A Building Permit?
YES r NO CIRCLE ONE PP —
SHADED AREAS OFFICE USE ONLY �T'l.0
•New Address: / • ` • '_/11' I■
Postal District: • M • . / - ~
Real Milepost: Road #:
Left Right Fire District 5 Building Permit# C(4-1041 Plate Sent.. / 14/ �t
Or
Odd Even Date Paid(.t. /6 /( \Check# \5 a 1 Receipt# [D5 637 Date in Computer/14/(I
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TITLE: NANCY CLAASSEN NEW RESIDENCE NANCY CLAASSEN , ; ,c
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lima: i SITE ADDRESS: 1663 EAGLEMOUNT RD 4246 HILL ST APT B2
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- mmir __ PARCELL # 901304009 PORT TOWNSEND, .WA _ .,
98368 al ,
:1116411141. -I; HOME PH: 379-6616 ill& IS t-,11
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