HomeMy WebLinkAboutBLD1992-00421 00 %
*JEFFERSON COUNTY BUILDING PERMIT APPLICATION
BUILDING TYPE IMPROVEMENT TYPE
' SINGLE FAMILY NEW BUILDING
❑ MOBILE 0 ADDITION 500+/500-
O MODULAR 0 ALTERATION
®"' GARAGE ATTACHED-ETACHE ❑ REPAIR
B'' WOODSTOVE 0 DEMOLITION
O MULTI-FAMILY/UNITS ❑ RELOCATION
❑ COMMERCIAL
❑ INDUSTRIAL
❑ HOTEL/MOTEL/DORM/UNITS
❑ OTHER UBC OCCUPANCY GROUP _____
DESCRIPTION OF IMPROVEMENT: N e a. 041 5rfl (...,x7, / { 011.
SQUARE FOOTAGE PRINCIPLE TYPE OF HEATING FUEL
�/
MAIN FLOOR t 9 -T el , 3 TriW ELECTRICITY 0 OIL
2ND FLOOR 0 WOODSTOVE 0 GAS
3RD FLOOR 0 HEAT PUMP 0 OTHER
HTD BASEMENT
UNHTD BASEMENT
CARPORT ' 70.g 0 PRINCIPLE TYPE OF FRAME
GARAGE 7 D 2 ,0 (�
DECKS 7 Z.0 /3"V ® WOOD 0 - MASONRY
COMMERCIAL 0 MANUFACTURED 0 OTHER
INDUSTRIAL 0 STRUCTURAL STEEL
OTHER
TOTAL VALUATION !- - 4 ' OR ESTIMATED COST* 5-0�.000
❑ INSTALLED 19_
TYPE OF SEWAGE DISPOSAL: 0 SEWER SEPTIC SYSTEM
Ct NOT INSTALLED
Peg.n1sr 4t. Set' 9. o0/ 3
TYPE OF WATER SUPPLY: PRIVATE iirDRILLED WELL OTHER
PUBLIC 0 CITY OTHER: NAME
0 PUD STATE I.D.
=
NUMBER OF EXISTING BEDROOMS NUMBER OF EXISTING BATHROOMS �/
NUMBER OF PROPOSED BEDROOMS 3 NUMBER OF PROPOSED BATHROOMS 2 A,,
TOTAL NUMBER OF BEDROOMS 3 TOTAL NUMBER OF BATHROOMS 2 4
=
NAME OF ADJACENT BODY OF WATER
BANK HEIGHT SETBACK
9
SIGNATURE ' fLG /� _ ,.4.7 DATE �3®/f2--
APPLICANT NAME (PLEASE PRINT) PI/c/,',Q EL- R , v/loci1 ,
,I