HomeMy WebLinkAboutADR2008-00157 • ADDRESS REQUEST 1t-
JEFFERSON COUNTY PERMIT CENTER FE8 1 2008
621 Sheridan, Port Townsend, WA 98368 (360)379-4450
APPLICANT: Please fill out item 1 through 8. Fee as per Jefferson County F 'ii
1
fircelir.;'NewAddress ❑ Correction ❑ Change ['Review DIFF LEFT M.P. RIGiFIT" i�
2. Applicant Name: 6 ley)(-1 G VeG0
3. Mailing Address: P✓ 6 OX /17
Town/State/Zip al keki E/C/q 78 3 7‘
4. Telephone: Work 360 5'3/a7/ZHome: 360 7?`16.Zee
5. Location: Attach a Detailed Drawing or Map.
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Additional Fees May Be Required if More Than One
Site Visit Is Necessary x.06
*******PLEASE FLAG YOUR DRIVEWAY.*******
Date Flagged: a/ / /vP Flagging Color Pee( —
/,�j/y �,y Industrial Efficiency Alliance
Nine Digit Tax Parcel Number , yr '5 ace ^� Advancing Continuous Energy Improvement
Plat Name /7PeV>eel t. Block Lot f/� /,r,,i�u 6-a,x.�
6. Road Nam •• it. 5,ry/ce R Q:/o ��� ✓ rah �
Is this PRIVATE r COUNTY road? CIRCL ONE
Nearest oss Road: jQ:y,i Cie k 1r '
7. Neighbors' Address if Known:
Name/Address: /vvl tYO)i�- — «;N
t,1.t�t,�.,
Name/Address: 5-70 kiln, �Yl°��,e /2o d — ,1 /
8. Do You N o Construct a Driveway? www.industrialefficiencyalliance.org
YES or NO CIRCLE ONE t i
FIELD NOTES 1
9. Was This tted With A Building Permit?
YES or NO CIRCLE ONE P I a--i_S
SHADED AREAS OFFICE USE ONLY 1
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111011T TOWNSEND PAPER CORPORATION PURCHASE ORDER P.O.#: 08-001661
Order Date: 03-Feb-2008
PO Box 3170 Page: 1
Port Townsend,WA
98368
Buyer: YVONNE STARKEY
Phone: 360-379-2150
I Invoice only to the above address and Fax: 360-385-3692
enclose a copy of the bill of lading. Email: ones @ptpc.com
Vendor lop l u
JEFFERSON COUNTY PERMIT CENTER 100 Paper Mill Hill Road Payment Terms:CO CHECK
621 SHERIDAN ST Port Townsend,WA F.O.B.: PORT TOWNSEND
PORT TOWNSEND WA 98368 98368 Freight: FOB
Telephone: Fax: Ship Method Vendor
(360) 379-4450 Ship Terms: Prepaid
Line Descri)tion Units •uantitx Tax Status Unit Price Amount
1 ADDRESS REQUEST FEE TO GET STREET ADDRESS FOR EA 1.00 Exempt 156.0000! 156.00
QUIL DAM HOUSE
Source Requisition:0092437 0001
Deliver By: 06-Feb-2008
TOTAL: 156.00
c""70..A4/7
PPS
2,4 1paoh ns , 30. 37g ° °7 '
)441e-, le -14" ' j/L11 Aj2ja t2
-71 Vat- c21
P.O.Number MUST be on all invoices and shipping papers.
JEFFERSON COUNTY DC-ID NO.
DATE I.� kfic
RECEIVED FROM PT Po p .r Corp
DESCRIPTION BARS AMOUNT
V
OC6\M`5 Car Q CURRENCY 6-1 ' 1 '
CYO: eta_Ke * Ca bin OY\ a
ECK0
3.123Q 3 m
,(A p 14 33
8
RECEIVED BY 61--1) TOTAL 1 5G Ov
Port Townsend Paper Corporation 07-Feb-2008
Vendor: 00686 JEFFERSON COUNTY PERMIT CENTER 382293
Invoice Invoice Date Voucher Description Gross Discount Net
2408 04-Feb-2008 000000224074 08-001661 156.00 0.00 156.00
Total: $156.00