HomeMy WebLinkAboutADR2008-00102 ,
ADDRESS REQUEST
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,.{ 2 8 L008
1. J New Address El Correction El Change ❑Review DIFF LEFT M.P. RIGHT DIFF
A(
2. Applicant Name: rh (a �'e7
A
3. Mailing Address: (s(( v J. Fi-t-Lk �j Hbv( V __ .
Town/ State/Zip Port WAc1IocL ,,JA `t.S 351
4. Telephone: Work(206)(sIS• 3q{S2 Home: (361:6 371•oSSq
5. Location: Attach a Detailed Drawing or Map.
Additional Fees May Be Required if More Than One
Site Visit Is Necessary ' e.. Stk. ? el
*******PLEASE FLAG YOUR DRIVEWAY.*******
Date Flagged: .j/2S/og Flagging Color - (et:1
Nine Digit Tax Parcel Number 7621-1/00 165
Plat Name1Iforaak 6-ie 1 k(/!Block Lot 7
6. Road Name: 5\6‘.• • _ • 0 tike_ Le,i _
Is this a PRIVATE or COUNTY ,ad?CIRCLE ONE
Nearest Cross Road: V\/aSki ny-i-o6 I.4r.Q,
7. Neighbors' Address if Known:
Name/Address:
Name/Address:
8. Do You Ne d To Construct a Driveway?
YES or NO CIRCLE ONE
FIELD NOTES
9. This Submitted With A Building Permit?
or NO CIRCLE ONE
SHADED AREAS OFFICE USE ONLY �a
New Address: 133 S hco10643,b Tooke_t-s 1, FP ve
Postal District: • or-1- &,'C)C 3 } CC Oa 1 C \/
Real Milepost: L t3 Road#: W
Left Right Fire District t- ) Building Permit# Plate Sent 6 k 01. /(3t
Odd Even Date Paid`{ .Q$ 4' Check# LIB$ Receipt# fl )3 L. Date in Compute l5 / /4 CT-
T> Li )0v - 1aa -'1 `_Nt3
(.1 CI
CL_ -, 47). Da 1z'3