HomeMy WebLinkAboutBLD1993-00738 JEFFERSON COUNTY UNIVERSAL PLOT PLAN AND DEVELOPMENT APPLICATION
(This is not a permit)
Fill in the following information a as`completely as possible
OM ER OER NAME AEC'
. f `G 1 R4 O / (�ONE j`�43-C _3 )
MAILING ADDRESS E; \ PiI` - '
CITY/STATE , ZIP
APPLICANT MAME (if different) PHONE
or AUTHORIZED REP (circle one)
MAILING ADDRESS
SEPTIC DESIGNER t, iii)r_ PHONE
MAILING ADDRESS
GENERAL CONTRACTOR 1 E.. ^'r N) ! r P C
MAILING ADDRESS :6f PHONE 3 — � '
STATE LICENSE NUMBER I e L-L ( L- /� EXPIRATION DATE ‘
ARCHITECT PHONE
MAILING ADDRESS
LOAM LENDER MAME/BOND HOLDER MANE
MAILING ADDRESS PHONE
SITE ADDRESS:
911#/ROAD MANE L \ / &t - ` P ZIP CODE 7 ✓c..„(;?
LEGAL DESCRIPTION: -
SUBDIVISION NAME : -f t- ( -- ( � 7 LOT 2-° BLOCK DIVISION 7
TAX NUMBER 9 DIGIT PARCEL NUMBER 9 — 000 — --7
SECTION TOWNSHIP 3 c) ' NORTH RANGE I WM
DESCRIPTION OF IMPROVEMENT: l7 � pc-IL(4 7y, J () ,„)
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
development of your property. ****
Mailing address: Jefferson County Permit Center, 621 Sheridan, Port Townsend, WA 98368
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- Legend ---
Contour Lines 0 Water Tap ----I
Property Lines .. V Phone Tap I _
Roadway 0 Electrical Tap
- al-AREA- 8D50D SO FT. Drainage 3/4" Iron Pipe -
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LOT
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