HomeMy WebLinkAboutADR2008-00135 ECE
ADDRESS REQUEST
JEFFERSON COUNTY PERMIT CENTER JAN 1 5 Z�Qg
621 Sheridan,Port Townsend,WA 98368 (360)379-4450
APPLICANT: Please fill out item 1 through 8. Fee as per Jefferson County Fen
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1.$1 New Address ❑ Correction ❑ Change ❑Review DIFF LEFT M.P �OIJN
2. Applicant Name: I (AV let _ I .
b
3. Mailing Address: P O o-N( 13 I A
Town/State/Zip M"-f Had. 10 C� AAA A ClE
4. Telephone: Work0-3�Tj- 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 Ore(a�
Nine Digit Tax Parcel Number 4Co`a-700CD(-4 G
Plat Name I Block n Lot
6. Road Name: '7 T'l7i 1 le K
Is this a PRIVATE o 0 'ad? CL CLE ONE
Nearest Cross Road: IN RI Kba 61\ 114
7. Neighbors'Address if Known:
Name/Address:
Name/Address:
8. Do You Need To Construct a Driveway?
YES or NO CIRCLE ONE
FIELD NOTES
9. Was This Submitted With A Building Permit?
YES or NO CIRCLE ONE
SHADED AREAS OFFICE USE�ONLY (�� �.(f PP
New Address: 1 1-E' 311) ' V.c m e. ?cL• ,3(`.4 J v
Postal District: PO — !—t( '0e44j � a f
Real Milepost: , Road#: p (� (/
Left Right ire District -if I Building Permit# Plate Sent \ /I"7 O 6
Or
Odd Even J2fate Paid 1 / IS/O%Check# ) S .°\ Receipt# G615.53 Date in Computer i / /p6
Ian - iaarryom
r, \& 9 $ , aaa-)w
Sweet Mme 12J L6c 4-0
Lot 42 9'1
Ok
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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 respec
correctness or validity. Data contained in this map is limited by the method and accuracy of its collection. Tue Jan
2008
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http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&ClientVersion=4.... 1/15/2008