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HomeMy WebLinkAboutBLD1999-00691 40co� Jefferson County Permit Center * Department of Community Development (,.‘" 19' � 621 Sheridan Street Port Townsend WA 98368 [360]379-4,450 aili'� r3 ).--'4711; URVerSd 4 �. ;. fl©t )frn ..,-- ,0 ,ill is, tic id oevia lta aka as eomk ete4 aQ A44difle: Project Description: h-� ' b ( 4 9 Digit Parcel Identification Number(from your tax statement): CI o 1 f7 c Site Address 911#: e ' Road Name:u,); V A p t , Zip Code: ?, f Legal Description , c y-- r-: Subdivision Name: �P O " Block: Lot(s): r Section: Ln 3 /} 0 1 ' `i)' Township: .�_..`.� . , , Range: Parcel Size (acres or square footage): i J a. 6 �� Property Owner:c--- - Phone: — :3-1 Rom,3 - `�\ .�C``�� � �t�..�,�r`��r'"" (cz�1 . � J 1 - =ate --f Mailing Address: 1--',v- (V 4 _LP: 1 Applicant/Occupant: I Phone: (if different from owner)\j\ 1)bajd C cr3 : , . L _ (9 '- Za )-- IC)f Mailing Address: i� �. l '' Authorized Re j,j1/4_9), L. L,,c Phone c, ::,,,,...7, _ (..,,,,„.::,,,,, Mailing Address: ' c j^ *4\ 4_� i r i pq General Contractor: I, ,, C Or Manufactured Home Installer: (y--- - , `17E:4 ( Phone: _ c; =�Ts'.�- _ j Co Mailing Address: '? . 4 f { Contractor's State License Number: E, I Expiration Date: / i 1 Q..„,o3c. Septic Designer: \ A Phone: Mailing Address: Architect:/Engineer: Vi , e cr,w (> 4 , ( Vic. Phone`. Mailing Address: 5- l •C \ (c p. ( ir`-,1! ',-). 0, „ Loan Lender/General _ Phone: Contractor's Bond Holder: ;,m �)� t. — 2 L0- /q —5: Mailing Address: - L.tpy FOR OOri LISE ONLY Fire District .. Platming Axea... .: School:Distritt: 1 ....... ..: Zone: 4/98 H:\home\pincntr\forms\universal plot plan