HomeMy WebLinkAboutADR2008-00074 a
ADDRESS REQUEST RECEI VED
JEFFERSON COUNTY PERMIT CENTER
621 Sheridan, Port Townsend,WA 98368 (360) 379-4450 MAY - 2 no
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: C)o �� dgs,,t I/JAI L
3. Mailing Address: 34S 11;c3J-04,10 Ast. Q„mot
Town/State/Zip q„;knw. ■ #j\ cf$3 'C
4. Telephone: Work - Home: It -pis rr
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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 —_-'
Nine Digit Tax Parcel Number 1S `1.00
Plat Name 5 R hq ...xi Block Lot
6. Road Name: Srle �,t� --
Is this a PRIVATE or COUNTY road?CIRCLE ONE
Nearest Cross Road:
7. Neighbors'Address if Known:
Name/Address:
Name/Address:
8. ou Need To Construct a Driveway?
YE ' or NO CIRCLE ONE
FIELD NOTES
9. Was This Submitted With A Building Permit?
E J or NO CIRCLE ONE
r __SFIADED AREAS OFFICE USE ONLY P �?v7
-
New Address: Y4 1 �j K V((!t) 04. p r , r
Postal District: Q 1 ,-e, -e
Real Milepost: ° _- Road #:
Right Fire District
�— -- - - Building Permit# � - ��-3
Plate Sent 5- 0
Even Date Paid 5 / /C>jCheek# 5 11 Receipt# g ei i{� Date in Computer /1 )1
5 5 ton -Ias
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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
in this map is limited by the method and accuracy of its collection. Mon May 05 14:11:18 2008
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