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Jefferson County Permit Center, 621 Sheridan St, Port Townsend WA 98368
UNIVERSAL PLOT PLAN
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Project Description:9 Digit Parcel Identification Num eer (from Your tax statement) Ct 3 8 Ltoo 7
Site Address: � J)
91 1# & Road Name - t R- Dom.. p,2 3V n-itia ji.Azi►ir,.
Legal Description:
Subdivision Name C..PrPE-- +C..c.�„fa.,Ore C.,t,f.otvY Block 8 Lot(1) 1
Section (2 Township 5a North,Range 2_/A i WM
Parcel Size (acres or square footage) 121 qaz .42 .sq �T
Property Owner (sow, Iemik IJo-V Phone 39S asg7
Mailing Address 1 6'0 6Y1/1'P4=4. bF ) P-F qg,3
Applicant/Occupant (.toy-►�i- .r .sln4 t„uS�,� �+ rE�2�ct- Ct AtctvT2._ Phone 5 ,6 774t qz14
(if different)
Mailing Address '174c> ivo f >F c'to of LA-)fir cta3-76
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Authorized Rep Phone
Mailing Address
General Contractor Phone
Mailing Address
Contractor's State License Number Lo N t-t'L�J Gr )5�it 17►J Expiration Date 3/t 1 q�•
Septic Designer ex . StC PTi . 1S G—x X s'n - c - Phone 3 _048v
Mailing Address - oc_ae_,sc. /C y.lw).A-c.uw OD �o►Zr TP1.•NoS D
Architect t� t�tz-6r� F-5 c„A R-- Phone 3 60 9 e?
Mailing Address S .pcw tk?rj )Pt- g837D
Loan Lender/General V-t,‘)p,,,,,cEa Ce , ,r 100 41 Phone 3$5-o6-.Q7
Contractor's Bond Holder
Mailing Address Gf� tC - 470 PScX q2_/ ( S -h-t- Z.e 98t.oat - 027
FOR OFFICE,USE ONLY
Fire District Planning District School District Zone ..
Case Number ► #;.�