HomeMy WebLinkAboutBLD1999-00599 4. gsoic coy Jefferson County Permit Center Department of Community Development
,� 621 Sheridan Street Port Townsend WA 88368 t360]379-4450
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Project Description: '"
9 Digit Parcel Ideyitification Number (from your tax statement):
Site Address jYiA ,e,.li- Pt 1 1 P .
911#: Road Name: Zip Code: ` e 3 ram,
Legal Description Di V
Subdivision Name: CA p s, , 'r(,w ::, 5 VI c.c A LI Bi 0ek- 3 Lot(s): 41
Section: / 3 Township: 3, N Range: 2-
Parcel Size (acres or square footage): A pp,,a, /at 4."
Property Owner: / E. Phone:
Mailing Address: b 2✓ V /!3.. (i e,A A t i , .-"-,!g. LA-I A 4 rE .,,1
Applicant/Occupant: Phone:
(if different from owner)
Mailing Address:
Authorized Rep: Phone:
Mailing Address: _
General Contractor:
Or Manufactured Home Installer: R.., -p _,, c; ,, Phone: 3f,s'-2''3 I
Mailing Address:
Contractor's State License Number: Expirati n Dare:
Cc,Si I eSf3 a ca-�.,-ou
Septic Designer: Phone:
v '- R!of ' 4,„J tfr !Ai e.s
Mailing Address:
t s - t— r i'J(u Li,' 5.r , s l fr ! 7, ,<= , e, 2 3 ?,
Architect:/Engineer -- �- Phone:
tic.i�Y9',.! ,'1,., -r4+,$ .. lo 44(-S 1-'-u�� L 1,,..,'AI a -Ni`w /-r.�,O€3 -2-S C' S-7 3 E3
Mailing Address:
y 2- r4,41 ftJ 31 f_.f 24) t�a%; 3'71 7 i''dl :�Dt.:<'-°".;: ,i 1�� O t',, . -:,`7
Loan Lender/General Phone:
Contractor's Bond Holder: 3r74.1 'l /fe ; ; i r'4AJ Sr tier yy!'
Mailing Address:
.2 / )I Lkjit ? e AJ ea'r At Sr. P.-. &ilk & 3( '
FOR OH-q(.-E USE;ONLY
Fire District Planning ..
'Area: �, School Dlsmet: I VD. Zone:
4/98 H:\home\pincntr\forms\universal plot plan