HomeMy WebLinkAboutBLD1993-00329 o . , -
*JEFFERSON COUNTY BUILDING PERMIT APPLICATION
BUILDING TYPE IMPROVEMENT TYPE
SINGLE FAMILY ' NEW BUILDING
❑ MOBILE ❑ ADDITION 500+/500-
❑ MODULAR ❑ ALTERATION
❑ GARAGE ATTACHED/DETACHED ❑ REPAIR
❑ WOODSTOVE ❑ DEMOLITION
❑ MULTI-FAMILY/UNITS ❑ RELOCATION
❑ COMMERCIAL
❑ INDUSTRIAL
❑ HOTEL/MOTEL/DORM/UNITS
❑ OTHER UBC OCCUPANCY GROUP
DESCRIPTION OF IMPROVEMENT:
SQUARE FOOTAGE PRINCIPLE TYPE OF HEATING FUEL
115 fic17(7
MAIN FLOOR ❑ ELECTRICITY ❑ OIL
2ND FLOOR a I X 26 /SLR) ❑ WOODSTOVE GAS
3RD FLOOR ❑ HEAT PUMP ❑ OTHER
HTD BASEMENT 1055 c Q- j al J
UNHTD BASEMENT K
CARPORT PRINCIPLE TYPE OF FRAME
GARAGE (,ofl 0 X/U 6C30
a
DECKS 3-1'.-. //O WOOD ❑ MASONRY
COMMERCIAL ❑ MANUFACTURED ❑ OTHER
INDUSTRIAL ❑ STRUCTURAL STEEL
OTHER
TOTAL VALUATION ,A 2��j 2(Q� OR ESTIMATED COST
❑ INSTALLED 19 611
TYPE OF SEWAGE DISPOSAL: ❑ SEWER › SEPTIC SYSTEM
❑ NOT INSTALLED
TYPE OF WATER SUPPLY: PRIVATE ❑ DRILLED WELL OTHER
PUBLIC CITY OTHER: NAME
❑ PUD STATE I.D.
NUMBER OF EXISTING BEDROOMS NUMBER OF EXISTING BATHROOMS
NUMBER OF PROPOSED BEDROOMS NUMBER OF PROPOSED BATHROOMS Y
TOTAL NUMBER OF BEDROOMS .�J TOTAL NUMBER OF BATHROOMS 4/
NAME OF ADJACENT BODY OF WATER N
BANK HEIGHT , SETBACK
SIGNATURE Aita ie.S-47,-€ K DATE 4/1-< q3
APPLICANT NAME (PLEASE PRINT) De/v.v./5 4, ,3P_ o1�6,ff 4'