HomeMy WebLinkAboutBLD1995-00093 Jefferson County Permit Center
621 Sheridan St
Port Townsend WA 98368
UNIVERSAL PLOT PLAN
Fill in the following information as completely as possible.
Project Description: /V r J 5.1` 4/'c S1-r i) c
9 Digit Parcel Identification Number (from your tax statement) 76 — D 60 Q`.0
Site Address: �/
911#/Road Name .J - 1 LJDi/.} riiu) Oi<" Zip Code
Legal Description: / •/
Subdivision Name: LGwLb3 p . VZLi E,E ,1) -� 1. Block Lot(s) Ai
Section .1 Township L North Range it---
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Parcel Size (square footage or acres)
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Applicant/Occupant R A/ Phone C
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Mailing � h_tilfz. 42_ of--- - � /M a g Address 3 Lq- /(/, J. ,i/
Property Owner (if different) Phone
Mailing Address
Authorized Rep /4in -- 1-4--- /v Phone
Mailing Address glib/ 4 (' ` '`-2) _7M-' c.ttJ 9 L‘ ---
Septic Designer N��_ Phone
Mailing Address
General Contractor /"',,2.9- / _— /��� Phone
Mailing Address q /p/ 44 13711 , �a27- CGi,a L0
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State License Number Expiration Date Z/9/,
Architect ,t/i)47- (al ki) Phone
Mailing Address /(6// 5. /S Si -Z0"7/ 6i,14vct4, 91/60_1
Loan Lender/Loan Holder �j,tre;Zt,) - S4-1, d�y Phone
Mailing Address ,Tj-✓l 14: 4 j-
t FOR OFFICE USE ONLY
Planning Area Fire Dist_____T
School Dist :f'4 Zone :: ( El:v...Plncnbvformsvpbtpin3
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