HomeMy WebLinkAboutBLD1993-00375 •
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**JEFFERSON COUNTY MOBILE HOME INSTALLATION PERMIT APPLICATION
:I71.116 TYPE IMPROVEMENT TYPE UBC OCCUPANCY
MOBILE ❑ NEW BUILDING GROUP
SIZE 2-$ 4
YEAR 1C1CA(
MAKE 16/- ,F.,--)C_C_ ( I ,k,Pr-t-s)
COST
DESCRIPTION OF IMPROVEMENT:
TYPE OF SEWAGE DISPOSAL: 0 INSTALLED 19
0 SEWER V INDIVIDUAL SEPTIC _
0 NOT INSTALLED
TYPE OF WATER SUPPLY: PRIVATE ❑ DRILLED WELL OTHER
PUBLIC CITY OTHER: NAME
❑ PUD STATE I.D.
NUMBER OF EXISTING BEDROOMS .q NUMBER OF EXISTING BATHROOMS ,, v
NUMBER OF PROPOSED BEDROOMS 3 NUMBER OF PROPOSED BATHROOMS
TOTAL NUMBER OF BEDROOMS -3 TOTAL NUMBER OF BATHROOMS ,—fir. c)",....._,
IF WATERFRONT PROPERTY NAME OF ADJACENT BODY OF WATER
BANK HEIGHT SETBACK
SIGNATURE � —I ... ✓ U E DATE 6/6,..AS
APPLICANT NAME (PLEASE PRINT) TCeTh1'y—)4 �-1; 'r+(v44":1 N\
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FOR OFFICE USE ONLY
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT 1
J
BASE FEE .�— /
iii
PLAN CHECK _ ^4—j:—ZP—) RECEIPT # l
STATE SURCHARGE
4
J f li' \s\ .
TOTAL -I CASH/CHECK # /
V
/ if
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