HomeMy WebLinkAboutBLD1992-00369 6
*JEFFERSON COUNTY BUILDING PERMIT APPLICATION
BUILDING TYPE IMPROVEMENT TYPE
SINGLE FAMILY h'( NEW BUILDING
❑ MOBILE 0 ADDITION 500+/500-
O MODUL ❑ ALTERATION
>� GAR GE ATTACHED E HED 0 REPAIR
0 WOOD ❑ DEMOLITION
O MULTI-FAMILY/UNITS ❑ RELOCATION
O COMMERCIAL
❑ INDUSTRIAL
❑ HOTEL/MOTEL/DORM/UNITS
O OTHER UBC OCCUPANCY GROUP
DESCRIPTION OF IMPROVEMENT:
SQUARE FOOTAGE PRINCIPLE TYPE OF HEATING FUEL
7-0
MAIN FLOOR 1'3 X ��3 0 ELECTRICITY 0 OIL
2ND FLOOR 0 W00DSTOVE 0 GAS
3RD FLOOR h 7 47 /P b I HEAT PUMP 0 OTHER
HTD BASEMENT I'Li'3 ��
UNHTD BASEMENT
CARPORT ^ PRINCIPLE TYPE OF FRAME
GARAGE 5-7 2 5-/7-0
DECKS `{c C `1 _CO O K. WOOD 0 MASONRY
COMMERCIAL 0 MANUFACTURED ❑ OTHER
INDUSTRIAL 0 STRUCTURAL STEEL
OTHER �/
TOTAL VALUATION U 0 OR ESTIMATED COST vic/cc ,�G
0 INSTALLED 19
TYPE OF SEWAGE DISPOSAL: SEWER ❑ SEPTIC SYSTEM
` 0 NOT INSTALLED
TYPE OF WATER SUPPLY: PRIVATE 0 DRILLED WELL OTHER
PUBLIC 0 CITY OTHER: NAME
PUD STATE I.D.
NUMBER OF EXISTING BEDROOMS NUMBER OF EXISTING BATHROOMS
NUMBER OF PROPOSED BEDROOMS 3 NUMBER OF PROPOSED BATHROOMS .3
TOTAL NUMBER OF BEDROOMS 3 TOTAL NUMBER OF BATHROOMS J
NAME OF ADJACENT BODY OF WATER
BANK HEIGHT SETBACK C
SIGNATURE �/� .. ���r Ly-, DATE //I (GI L--
APPLICANT NAME (PLEASE PRINT) I41,V2T JG.NLU471Z&/L-