HomeMy WebLinkAboutCAM2019-00250Begin Time:End Time:
DEPARTMENT OF COMMIJNITY DEVELOPMENT
621 Sheridan Street, Port Townsend, WA 98368
Tel: 360.379.4450 | Fax: 360.379.4451
Web: www.co.iefferson.wa. us/commun iWdevelopment
E-mail:CsC.@.co.jgfferson.wa.us,
Customer Assistance Intake Form
Help us provide you the information you need by filling out this form.
This is a public information form, the contents of this form is available to view by the public.
o The first l5 minutes of staff time is free.
o After the first 15 minutes, a minimum of one hour will be
charged at the rate of $ 100.00 a hour with additional time over
one hour billed in I5 minute increments.
o Please complete form and submit to the address or email
above and a staff member will contact you.
. Our goal is to respond within l4 calendar days of the request.
Office Use Only
Receipt #:
Check/CC #:
Date Paid:
Received By:
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NAME:(-5L Sco P,V DATE:
EMAIL ADDRESS:Voe(V6-ooLx?aloc.,yrt
MAILING ADDRESS:
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TELEPHONE:
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PLEASE NOTE: lnformation and guidance provided through Customer Asslsfance is advisory onty and is based on
information provided by the customer. This is not intended to be an exhaustive review of all pofenfial lssues. Any discussion or
information provided shall not bind or prohibit the Coun$'s future implementation or enforcement of alt applicable laws and
regulations.No sfalemenfs or assurances made by County representatives shall in any way relieve the applicant of his or her
duty to submit an application conslsfenl with all relevant requirenents of County, state and federal codes, laws,regulations,
land use plans, and other
Your Signature:
Monday, September 29, 2014
Begin Time:End Time:
Customer Assistance lntake Form Page 2 of 2
lnformation Requested - List atl questions and any information you need addressed. Attach
additional sheets of paper if necessary.
Property Description
Office Use Only
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g.DIGIT PARCEL NUMBER Ta:< Statem
PROPERTY ADDRESS:
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;b Legal DesriiPt
r-10, Blk. 4
lrving Park
1-10, Blk. 5
Tax Parcel #
963 300 401
Assessed Value Real Estate Taxes
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s49,000.00 4 l*l,t* sso4'eo u*\Z.2
963 300 501 s54,250.00 Sss8.44
lrv Pa rk 385o s40.6e
s63.s2
5L24.6L
L,8-LO,34 963 303 401 4-2lrving Park
2, Blk.4L
lrving Park
3-5, Blk. 41
lrving Park
963 304 102
963 304 103
-6, Blk. 1 992 200 t1t s14,088.00-. 6tqyt 51.48.72 1.lQae
Salem
t-12. Blk. z
Salem
1-12, Blk. 3
Salem
L-Lz, Blk.4
Salem
1-16, Blk. 5
Salem
1-16, Blk. 6
Salem
1-16, Blk. 7
Salem
1-8, Blk.8
Salem
992 200 20L 52r,438.00 21,5223.72
eg*
Sar.{.q\\
992 200 301 521,438.00 74 *1
,
521,438.00 2.7587
5223.72
oN
992200 40L 5223.72
992 200 SaL s21,O7o.oo 2,,t71
s21,o7o.oo 2h, T
s237.88
992 200 601 s219.98
992 200701.S21,o7o.oo 2$,17?s219.98
992 200 801 s16,s38.00 lf'.lq, 5fi3.74
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try,t5o
lhrW
s3,500.00
s5,775.00
s11,725.00.
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CAM19-00250