HomeMy WebLinkAboutBLD1999-00640 1,sp14 C, Jefferson County Permit Center * Department of Community Development
°6, , 621 Sheridan Street Port Townsend WA 08368 (3601370-445D
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Project Description: /< t 5 of t f ; IA$ gp"j i ,IV .. $" &' �`r l 4 .u..e
9 Digit Parcel Identification Number(from your tax statement): nA i.' .�,,,. rye. /
Site Address
911#: -- Road Name: ' Zip Code:
Legal Description
Subdivision Name: C`1 , , .- rs i.l , '0 °'` Vol 3 do? Block: Lot(s): , ,. ' 2
Section: ' Township: ,g // Range: ,
Parcel Size (acres or square footage): ,
Property Owner: 1'2 '�p p¢n `" € Phone: roy #, • ,
Mailing Address: d }:1-� ,? l
¢ ,, .. f o emu, ° r r i r , ,,et.,4 " : , e.' 7 a
Applicant/Occupant: Phone:
(if different from owner)
Mailing Address:
Authorized Rep: ,_,__�.___ Phone:
Mailing Address:
General Contractor:
Or Manufactured Home Installer: j 'ti e t- ca Phone: " ,-'
Mailing ailing Address: 1(Y3OY1 d 140 ill e� (- 1A -2 j trr'\.
Contractor's State License Number: %06, Sc.-i• ( CA Expiration Date:
Septic Designer: /P % Phone: .. .. _.
Mailing Address: 2 /.: -L.Fn-
Architect:/Engineer: Phone:
Mailing Address:
Loan Lender/General Phone:
Contractor's Bond Holder t . ��c e
Mailing Address:
FOR ON-JCL-USE.ONLY
Fire District k i Planning Area: School District: - ,<1 i Zone:
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