HomeMy WebLinkAboutBLD2000-00779 Jefferson County Department of Community Development
" ON Co 621 Sheridan Street,Port Townsend WA 98368 (360) 379-4450
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';HING��$ Universal Plot Plan
Fill in the following blanks as completely as possible :
Project Description:
ensra e_ `1 ' O. cc , c_ c A et, 4 <-C i o E ke 5 (' f ,, er l pLz 'et
9 Digit Parcel Identification Number (from your tax statement):
a i 175"— 0n
Site Address 911#: f 1{ Road Name: C: t x 2.e i k s t_ Zip Code: `I", '.3 4_
Legal Description
Subdivision Name: Block: Lot(s):
Section: 1 7 Township: 3 0, 0 c i \ Range: i L� 1 P 54 1Jui 11
Parcel Size (acres or square footage): ; / 3 fl—C.
Property Owner: , j- ,,_,:Li w ,,, ` Phone:„ 6 0 ..� 5,. r, z i,
Mailing Address: / {�S'i7 c, , se t A-i" k C Pe,y-`f.Tot L-+.-5-e /4 cl ,� C F5 j 8-'`
Applicant/Occupant: Phone: 4�
(if different from owner)
Mailing Address:
Authorized Rep: Phone:
Mailing Address:
General Contractor:
Or Manufactured Home Installer: Phone:
Mailing Address:
Contractor's State License Number: Expiration Date:
Septic Designer: --- / Phone:
Mailing Address:
Architect:/Engineer: Phone:
C, be L-t "C `/,
Mailing Address:
Loan Lender/General Phone:
Contractor's Bond Holder: n le
Mailing Address:
FOR OFFICE USE ONLY
Fire District: Planning Area: School District: Zone:
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