HomeMy WebLinkAboutBLD1996-00231 JEFFERSON COUNTY UNIVERSAL PLOT PLAN AND DEVELOPMENT APPLICATION
(This is not a permit)
Fill in the following information as completely as possible
PROPERTY OWNER NAME `-%:;+C \*\.7)\QN, � PHONE
MAILING ADDRESS \'�{ } c� SK ,
CITY/STATE C(5a., me ZIP CO„:
APPLI (if different) �V �'.yy`4NS)taA \ Ti< stiCAMISPHONE Zoce. 5EZ-- 3`-(2.,S (Rc
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or HORIZED (circle one) --��4/ ✓
MAILING ADDRESS \C Z.c) 26- ' _ '' rr, .
SEPTIC DESIGNER '\\:\`�. ' PHONE Sri9 - c cC
MAILING ADDRESS C \
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GENERAL CONTRACTOR ENI ��3 `A\.-) r(0 nvJ � 9 C) �,�
MAILING ADDRESS \� ! �c c 1�( V� s PHONE ZQ(e 6'Z 3((Z3
STATE LICENSE NUMBER EVERC�V11it243C1/ EXPIRATION DATE q (3C) 119 `�'
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ARCHITECT / PHONE
MAILING ADDRESS ,
LOAN LENDER NAME/BOND HOLDER NAME { ��j S U 1(UG-S - k
MAILING ADDRESS (C)3 4 .2 ,�� �iE 59S 6c
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SITE ADDRESS:
9111/ROAD NAME 45 }, �l &40,,,c) ZIP CODE
LEGAL DESCRIPTION: ANC\``c\Q-.. i 'y 2`3
SUBDIVISION NAME �CiCk .,\
DIVISION aRls\-) 14
TAX NUMBER 9 DIGIT PARCEL NUMBER 'SC) 1 o CY :A
4.
SECTION TOWNSHIP 2. NORTH RANGE 1 WM
DESCRIPTION OF IMPROVEMENT: {L1(72_, (j, .. Y to (9._
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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