HomeMy WebLinkAboutBLD1995-00231 Jefferson County Permit Center
621 Sheridan St
Port Townsend WA 98368
UNIVERSAL PLOT PLAN
Fill in the following information as completely a-s-possible.
Project Description:
9 Digit Parcel Identification Number (from your tax statement) 001 061 005
Site Address: 12s H1] J63'S �'911#/Road Name JZ,Zip Code v
Legal Description: 146% e OF c �wr IA- OF n Y4 c ac(�OI4
Subdivision Name: TaNf1lp'0 laaAJeiP 1 U.A9g (,UM Block Lot(s)
Section Township 30 North Range talSr WM
Parcel Size (square footage or acres) 10.12 2 t`a _.>
Applicant/Occupant Rf am%► 2Eco .01r'0*1 Phone '2 t J 1
Mailing Address PO. 146 Fexr -Ne - Eg
Property Owner (if different) 4' lb Phone
Mailing Address
Authorized Rep ` *3 C•;�KWICT C I� A�}1i Phone 112
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Mailing Address 10• C td ` 1R T AMID qge
Septic Designer (Yo f & +� ma- l c&C�"t 11\VA� Phone
Mailing Address 4a, �.' • l 14-16J'
General Contractor PSCRER N { c 4/01%1 a.) L'VC, Phone J&51Q 4
Mailing Address 9). t.d 21 m dema
State License Number ,N.S aQ(j r'j D 8 1 Expiration Date /c 2,0 9
Architect ` IX / `,
~.11`I� l 4Y+ /4rjflR1S Phone 395‘ 2(4)t2
Mailing Address QJ 1 VW* airy # !O €?7 ,2 gsr2-6g
Loan Lender/Loan Holder Phone
Mailing Address
FOR OFFICE USE ONLY
Planning Area t Fire Dist - School Dist Zone i H;\...PlncntrUame1pbtpin3