HomeMy WebLinkAboutBLD2016-00564 - 01 PERMIT APPLICATIONApr 15 2021
AGENT AUTHORIZATION FORM
We hereby certify the above information submitted in this application is true and accurate to the best of our
knowledge.
Signature
_______________________________
Signature
_______________________________
Apr 15 2021
JEFFERSON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street | Port Townsend, WA 98368
360-379-4450 | email: dcd@co.jefferson.wa.us
www.co.jefferson.wa.us/commdevelopment
BUILDING PERMIT REVISION
Date
Regarding: Building Permit Number
Address
Parcel Number
Other Case Number/s
Submitted by: Phone:
Please complete the following, if applicable:
Permit Type & Square Footage
PERMIT TYPE: APPROVED SQ/FT: CHANGE TO SQ/FT: TOTAL SQFT:
Commercial
Residential
Garage/Shop
Accessory
Uncovered Porch
Covered Porch
Unfinished Basement
Other (Specify)
Estimated Fair Market value cost of changes:
No change to square footage
Apr 15 2021
Apr 15 2021