HomeMy WebLinkAboutBLD1999-00136 goo o Jefferson County Permit Carter ' Departm<nt of Community Development
<S, 621 Sheridan Street,Port Townsinil WA 88368(3601370-4450
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Project Description:
9 Digit Parcel Identification Number(from your tax statement):
Site Address /�
911#: i) Road Name:474'66/ Adit- /4( Zip Code: o...?
Legal Description
Subdivision Name: Block: Lot(s):
Section: Township: Range:
Parcel Size (acres or square footage):
Property Owner: "44 1� Phone:
elrc ✓von 4 r�v4C J � l e� 9 d. 7,77.6676
Mailing Address: ,s- / // e P
Applicant/Occupant: Phone:
(if different from owner) 44
Mailing Address:
Authorized Rep: Phone:
Mailing Address:
General Contractor:
Or Manufactured Home Installer: D ,, �L�,�f.��� Phone:
Mailing Address:
Contractor's State License Number: Expiration Date:
Septic Designer: Phone:
Mailing Address:
Architect:/Engineer:
/�.://44. fi he_ ( , 6„/1,�) Phone:140. c L3068
Mailing Address:
Loan Lender/General Phone:
Contractor's Bond Holder:
Mailing Address:
b rICE:USE OT'/LY;
Fire Dismct......>... .. Planning Area: School District: Zone:
4/98 H:\home\pincntr\forms\universal plot plan