HomeMy WebLinkAboutBLD1995-00024 JEFFERSON COUNTY UNIVERSAL PLOT PLAN
(This is not a permit)
Fill in the following information as completely as possible
PROPERTY OWNER NAME re) Y1 S U SAW 8E W AJ Cr�ER PHONE ao6- t'I v7 5-
MAILING ADDRESS ` "CITY/STATE 00 5 ( AIKA c IS y�D,
1NG CITTY�Y/STATE F(l!/%J.VLOA) f !/lj! '4 ZIP $3 Z®
6p11ICANT NAMEcif different) PHONE
or AUTHORIZED REP (circle
MAILING ADDRESS j6r(A-ca44 L ,/'fv/' _
SEPTIC DESIGNER PHONE
MAILING ADDRESS
GENERAL CONTRACTOR A®A 3 tivm.e15 [ N C-
MAILING ADDRESS 2-30 3 "t GA- Avia Sal PHONE 5 ,o- 85 Z-164
OLI imp
( vJA e ` v5ty
STATE LICENSE NUMBER ADAl(L t4 2-47Ze-- EXPIRATION DATE ( - I?f 9
ARCHITECT R'O W E PHONE
MAILING ADDRESS
LOAN LENDER NAME/BOND HOLDER NAME P1 (' A V tyJ6r 5 QAryta(L Ott t~JA-
MAILING ADDRESS Po 60 q0 'i PHONE r®9- 5�7" 34.3C
f�Ort.A-A ,a - j 11 71 3&
SITE ADDRESS:
4 � l OW)
911#/ROAD NAME RIOT YET ASS/(net) POJt✓ LOALt.'7 S s1 aiZI/I1J)r1 ZIP CODE qa
LEGAL DESCRIPTION:
SUBDIVISION NAME LOT BLOCK DIVISION
9 DIGIT PARCEL IDENTIFICATION NUMBER 603 L'f 3 Do'1 SQUARE FOOTAGE OF LOT/LOTS/ACREAGE 1.0 3
SECTION 3'411- TOWNSHIP Z G NORTH RANGE 3 kW WM
DESC��RIIP�PTI�-OON OF IMPROVEMENT: $ll`kl0 A 3 eEQtlocsrw D(j) 5/M&i.A2
PLEASE FILL OUT ALL OF APPLICATION
The legal' description and 9 digit parcel number may be obtained from your tax statement or from the Assessor's
Office in the Jefferson County Courthouse.
Return to Jefferson County Permit Center, 621 Sheridan, Port Townsend, WA 98368
FOR OFFICE USE ONLY
PLANNING AREA I FIRE DIST LI SCHOOL DIST ' _ i; ZONE �' $ ADJ ZONE