HomeMy WebLinkAboutBLD1992-00486 JEFFERSON COUNTY UNIVERSAL PLOT PLAN AND DEVELOPMENT APPLICATION
(This is not a permit)
Fill in the following information as completely as possible
PROPERTY OWNER KAEE N e re CS'C' c,\ 3 .. vs-%1-c . C PHOiiEa >/.. q
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MAILING ADDRESS sceo \`J -- SS#
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SEPTIC DESIGNER d LS/ ( PHONE
MAILING ADDRESS
CONTRACTOR ( e7 i LA CYS T L P,"<" ''.-C27>LAAc\CI-Cc7 \ n .
MAILING ADDRESS �-o er 2a i m _ T ,. PHONEE 2
STATE LICENSE NUMBER CO \ LAW—.. ' 114t4 4=Ite EXPIRATION DATE
FEDERAL I.D. NUMBER ' \ 11% 5
ARCHITECT r '114--) 1 d 4C he, \\ PHOME;k 6. c j
MAILING ADDRESS P c:, j ?
LOAN LENDER NAME/BOND HOLDER MANE \1 ,
MAILING ADDRESS PHONE
SITE ADDRESS:
911#/ROAD NAME �S Y"� G (�'i pC)V _ZIP CODE
LEGAL DESCRIPTION:
SUBDIVISION NAME ` LOT 7r. BLOCK DIVISION
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TAX NUMBER�� . V7N ?144 DIGI7 PARCEL NUMBER g"k45 P ;\
SECTION I7 TOWNSHIP NORTH RANGE - / WM
.DESCRIPTION OF IMPROVEMENT: -; .C+'SC % c T"`'!N (''( 4 L_s 1
PLEASE FILL OUT ALL OF APPLICATION
**** Dear Property Owner: Please fill this form out as completely as possible. 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. Please make yourself at least one copy of this form so that you may use it for future
py 45Afw.
development of your property. ****
Mailing address: Jefferson County Planning & Building Department, PO Box 1220, Port Townsend, WA 98368
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