HomeMy WebLinkAboutBLD1992-00392 • •
JEFFERSON COUNTY BUILDING PERMIT APPLICATION
PROPERTY OWNER NAME�!-r/ O/G/4,4 // J I( CE`C_ PHONE ( a 4 4/ //9/(L
MAILING ADDRESS `/// G J. (,)�/9/e 1
/4' ZIP 9 / J�
CONTRACTOR r ���
MAILING ADDRESS M O4 _ ° AIL . �, S 2 2 / SS
STATE LICENSE NUMBER EXPIRATION DATE
FEDERAL I.D. NUMBER
ARCHITECT KA LL,S EN STRO USE. I 5I-1 I F4A(ZA PHONE �-4 " S4 S 4-
MAILING ADDRESS 3 i v F I R ST S O U T H - r2 c c N-1 3 3 2.
S EAT(L-E - -'A . c:9 ) O -
LOAN LENDER NAME/BOND HOLDER NAME
MAILING ADDRESS PHONE
SITE ADDRESS: j / L:(.2/j
911#/ROAD NAME / -/ /E O/1l S d/�/ (� ZIP CODE 9cf5 3 72'4
LEGAL DESCRIPTION:
SUBDIVISION NAME N O 12-T H 1 S"O FT 6-IOU-T. LOT - BLOCK yy� DIVISION
TAX NUMBER 9 DIGIT PARCEL NUMBER (QC) I c&2. GYJ
SECTION ?j' TOWNSHIP 2.-.6› N NORTH RANGE I InJ WM
BUILDING TYPE IMPROVEMENT TYPE
A' SINGLE FAMILY 40 NEW BUILDING
❑ MOBILE 0 ADDITION 500+/500-
❑ MODULAR 0 ALTERATION
O GARAGE ATTACHED/DETACHED 0 REPAIR
❑ W000STOVE 0 DEMOLITION
O MULTI-FAMILY/UNITS 0 RELOCATION
❑ COMMERCIAL
❑ INDUSTRIAL MOBILE HOME
❑ HOTEL/MOTEL/DORM/UNITS SIZE
O OTHER YEAR
MAKE
UBC OCCUPANCY GROUP h� COST
DESCRIPTION OF IMPROVEMENT: N 5-K) Z ^ STOIzy 9$O S.F. CAB I Ni
PLEASE COMPLETE BOTH SIDES OF APPLICATION
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