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HomeMy WebLinkAboutBLD1994-00004 • / • JEFFERSON COUNTY UNIVERSAL PLOT PLAN AND DEVELOPMENT APPLICATION (This is not a permit) Fill /ip the following info mattionn as completely as possible PROPERTY OWNER NAME ,t�i /7�,� ��"7/, PHONE e�J' %— /C, `2 MAILING ADDRESS f/ j a///t/ / -e‹- CITY/STATE ZIP grilf? APPLICANT NAME (if different) PHONE or AUTHORIZED REP (circle one)(-7 MAILING ADDRESS SEPTIC DESIGNER /(' 7 (27sy."/C:Ir/ ,t/C(; PHONE MAILING ADDRESS27 ) '),O16- 27i/ • C�T / 67:}4)ccE4I' 4' GENERAL CONTRACTOR (-24(. 1_1(31' MAILING ADDRESS . )/77/7d© PHONE STATE LICENSE NUMBER EXPIRATION DATE ARCHITECT �/w '• PHONE MAILING ADDRESS LOAN LENDER NAME/BOND HOLDER NAME MAILING ADDRESS-4/4cAi , 1272: PHON ADDRESS:SITE / f / .._ f CG 911f/ROAD NAME ZIP CODE LEGAL DESCRIPTION: --�� ,,L SUBDIVISION NAME'��jJ�hz,, ,4) l� /� LOT /3 BLOCK DIVISION TAX NUMBER 9 DIGIT PARCEL NUMBER 1f}d 46,0 ,I /22/ SECTION /272 TOWNSHIP r�6) NORTH RANGE � (/t./ WM DESCRIPTION OF IMPROVEMENT A,1' Ceve/' / I/! 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 - ; _. 1 "041.. I . I ; JJ,A, ' 7fr* ' of , TO id 1 ' i 2. , ; ; ' ‘44.7'..e,r` /I I ., , 1 i ;,,I , 0 1 1 . j ' ' i 1 I / , dew ' w : , ;I ,-4—, . . , 1 , , al ! It / , : , , i ,6,/ 1 tff , 1, .. 1 , , . i ,i , i 1 1 ' :,, , : , , , i , I j I Is-- \ ti sib I I i 1 I ii C i i C? I -- —'_. _ 1 --- 1 e ' 1,.., 11-- ..E.../ii-r-iy - • i 1 i 1 s _l _ ___,, 4 , I . I . , r _ #t 14; ; 1 I 3 i i i 4ff.A.,_4, — _ — 1 • . • V