HomeMy WebLinkAboutBLD1993-00598 • •
**JEFFERSON COUNTY MOBILE HOME INSTALLATION PERMIT APPLICATION
BUILDING TYPE IMPROVEMENT TYPE UBC OCCUPANCY
J MOBILE NEW BUILDING GROUP
SIZE .2g /X .? /
YEAR
MAKE L.94'P•e/C-,`/2-CA
COST 's . 6 o
DESCRIPTION OF IMPROVEMENT:
TYPE OF SEWAGE DISPOSAL: 0 INSTALLED 19_
SEWER ❑ INDIVIDUAL SEPTIC
0 NOT INSTALLLED
TYPE OF WATER SUPPLY: PRIVATE A DRILLED WELL OTHER JI I
PUBLIC ❑ CITY OTHER: NAME
0 PUD STATE I.D.
NUMBER OF EXISTING BEDROOMS '$ NUMBER OF EXISTING BATHROOMS &
NUMBER OF PROPOSED BEDROOMS NUMBER OF PROPOSED BATHROOMS .1
TOTAL NUMBER OF BEDROOMS 1 TOTAL NUMBER OF BATHROOMS 1
IF WATERFRONT PROPERTY NAME OF ADJACENT BODY OF WATER
BANK HEIGHT SETBACK
SIGNATUR � `t/ i�%� �_ / DATE P^/h-2--'
—LICANT NAME (PLEASE PRINT)
****************************************************************************************************
FOR OFFICE USE ONLY
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT
9. J/
BASE FEE
g� 3 07
PLAN CHECK �` RECEIPT #
STATE SURCHARGE l '
TOTAL CASH/CHECK #
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