HomeMy WebLinkAboutBLD1993-00104 •
SQUARE FOOTAGE 46 PRINCIPLE TYPE OF HEATING FUEL
MAIN FLOOR o2 0 %/ q 3 (i c ❑ ELECTRICITY ❑ OIL
2ND FLOOR —0-- ❑ WOODSTOVE ❑ GAS
3RD FLOOR --69" K HEAT PUMP ❑ OTHER
HTD BASEMENT --2.-
UNHTD BASEMENT
DECKS MI 5 0 41 q ' PRINCIPLE TYPE OF FRAME
CARPORT - 5-7w p WOOD 0 MASONRY
GARAGE 3.?c ❑ MANUFACTURED ❑ OTHER
COMMERCIAL ---- ❑ STRUCTURAL STEEL
INDUSTRIAL — -
2 /
TOTAL VALUATION OR ESTIMATED COST A 3 `� S
TYPE OF SEWAGE DISPOSAL:
0 SEWER INDIVIDUAL SEPTIC
TYPE OF WATER SUPPLY:
❑ PUBLIC Al PRIVATE ❑ COMMUNITY WELL ❑ INDIVIDUAL WELL
NUMBER OF EXISTING BEDROOMS NUMBER OF EXISTING BATHROOMS
NUMBER OF PROPOSED BEDROOMS 1 NUMBER OF PROPOSED BATHROOMS 2
TOTAL NUMBER OF BEDROOMS 3 TOTAL NUMBER OF BATHROOMS 2-
NAME OF ADJACENT BODY OF WATER /V
BANK HEIGHT SETBACK
SIGNATURE,; .Q /'/ /_� DATE .2/0'3
BASE FEE G<3. >-t)
PLAN CHECK _/I49 • O RECEIPT 4
STATE SURCHARGE 4•
TOTAL titz.,(,,,) V' CASH/CHECK
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