HomeMy WebLinkAboutBLD1992-00576 • •
***JEFFERSON COUNTY INSTALLATION PERMIT APPLICATION
PROPERTY OWNER NAME 41 Pi-CAA- LI vl G� PHONE '3 6 5-- - 6 3 1
MAILING ADDRESS t(O ZZc _ 3 ,pSt, 1.1� SS
Sr_Q.Gt±ft� l Wik- ( pry ZIP Cl i Z�
CONTRACTOR ad1/1O u.n/. ( e a c L j tvlS- 0.l-l-k'..G
MAILING ADDRESS PHONE
STATE LICENSE NUMBER EXPIRATION DATE
FEDERAL I.D. NUMBER
SITE
911#/ROADESNAME S OlCQ STGL-b'K-ZeQ. • COV- LucQlk W ` 1 P ` ZIP CODE q
1 i
U �SiloS
LEGAL DESCRIPTION:SUBDIVISION NAME Ste Q �CCC x L'c-1 LOT BLOCK r7 DIVISION
TAX NUMBER 9 DIGIT PARCEL NUMBER 0 L( IN -e..) 1
SECTION -34 TOWNSHIP Z .(\t NORTH RANGE
l E WM
DESCRIPTION OF IMPROVEMENT: 11.4 ec - eki$ft� J l-.)OOc2 Sf-Ove. 1.i5�[Q Cc.4. •0L'`-
SIGNATURE( l DATEir
********,** ******** ******** ** ******************************************(Z.(q7.,'
* ********************
FOR OFFICE USE ONLY
Planning Area Fire District School District
BUILDING TYPE IMPROVEMENT TYPE UBC OCCUPANCY
'
.7(
❑ NON WOD D NEW GROUP
4P ' FRAME TYPE
+igi'T ❑ WOOD 0 MANUFACTURED ❑ STEEL ❑ MASONRY OTHER
i,
ii.iiikii. BASE FEE
:::.A'N 4 5
PLAN CHECK RECEIPT #
" STATE SURCHARGE
sD /60/
ili,-111' TOTAL CASH CHECK '
,i„,„„.,,!:
,„,„
fl '' h:\HOME\PLNCNTR\FORMS\INSTALL.APP
p �
mi
t�ilE i;
ire
Ili
'' 'W,YS.',