HomeMy WebLinkAboutBLD1998-00548 „ON o Jefferson County Permit Center * Department of Community Development
1 621 Sheridan Street,Port Townsend WA 08368(3601370-44�50
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9'ili i de jollootgq. &a al. a4 eostifilete4 ad fodcifle:
It Project Description:
Keliki Si 0 i -Cary` r residencL mfai l ad d etrage,
Lgit Parcel Iden 'fication Number from your tax statement):
Site Address
911#: S) Road Name: i RaCzip Code: gi(6, _-_,5o
Legal Description
Subdivision Name: 1 CLL I \e..- V IT ic9 6 Block: Lot(s): 6)3
Section: Township: Range:
Parcel Size (acres or square footage):
Property Owner: poo„ ®® ce,G, Phone: - , �7 0
Mailing Address: 7�j i \ n 1 ay 1 V a pat R
Applicant/Occupant:Q \/\y C �/\{ 7) ) �Z�
Phone:
(if different from owner) '_;d 6
Mailing Address:
Authorized Rep: ,75--e-F Ry o er Phone: ' • i a7
Mailing Address. 7 ( Jj
1 t /Ca- ) Pa--I-- oo V ,, ° ”
General Contractor: �--i
Or Manufactured Home Installer: Phone:
Mailing Address:
Contractor's State License Number: R-DpEci) (� Expiration Date: ; 1.201qq,
Septic Designer: 4 Phone:
Mailing Address:
Architect:/Engineer: Phone:
Mailing Address:
Loan Lender/General • Phone:
Contractor's Bond Holder: I. ( r 47 6 7
Mailing Address: Keri
FOR d ICE.USE O LY
Fire District .A. .;..... . Planning Area -. School:District: 72;,� ..>. Zone:
4/98 H:\home\pincntr\forms\universal plot plan