HomeMy WebLinkAboutADR2009-00087•
--- ADDRESS REQ ST
C 77D
JEFFERSON COUNTY PERMIT CENTER
621 Sheridan, Port Townsend, WA 98368 (360) 379-4450
APPLICANT: Please fill out item 1 through 8. Fee as per Jefferson County Fee Schedule
1. ❑ New Address ❑ Correction ❑ Change ❑Review DIFF LEFT M.P. RIGHT DIFF
2. Applicant Name: 'Foy)(1,0. �E., 'A-12.1,
3. Mailing Address: PO BOK ! c
Town/State/Zip Pte: }-\ Pr LOCs� 130 4 ✓39( PLids-(
4. Telephone: o �
Sp(„c„ Home:
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: / / Flagging Color .4- 13��
1
L2,0Zfk.Dr;de-I
Nine Digit Tax Parcel Number 70/ 34,1-44 U $a-
(.o
Plat Name 5}EOkT PLA. ..]..Block Lot J'
6. Road Name: Z2o J1/r(N�
Is this a PRIVATE or COUNTY road? CIRCLE ONE
Nearest Cross Road: �\A cDd ro die.v-aro n 'Dr
7. Neighbors'Address if Known:
n k.cp c G.
Name/Address: RN s31 .b/oJg 78 D et v c
Name/Address: pui 1C. w"
98371.
8. Do You Ng To Construct a Driveway?
YES or CIRCLE ONE
FIELD NOTES
9. Was This Submitted With A Building Permit?
YES or (NO! CIRCLE ONE �_p tr-r yEl-)
SHADED AREAS OFFICE USE ONLY P IG1 L'
New Address: 7 a Dectc.:1 1 ,Dr-,
Postal District: LA. 1 1 C t�,he
a —
Real Milepost: , C l Road#: b,._ V
Left Rig t) Fire District Building Permit# (I) Plate Sent 9 /`
Or
Odd\ Even Date Paid ' / / Check# Receipt# Date in Computers 491 6
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FOR INFORMATIONAL PURPOSES ONLY-
Jefferson County does not attest to the accuracy of the data contained herein and makes no warranty with
respect to its correctness or validity. Data contained in this map is limited by the method and accuracy of its
collection. Fri Se• 18 09:53:30 2009
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