HomeMy WebLinkAboutBLD1996-00557 *JEFFERSON COUNTY BUILDING PERMIT APPLICATION .
BUILDING TYPE IMPROVEMENT TYPE
❑ SINGLE FAMILY ❑ NEW BUILDING
❑ MOBILE 0 ADDITION 500+/500-
O MODULAR 0 ALTERATION
❑ GARAGE ATTACHED/DETACHED ❑ REPAIR
❑ WOODSTOVE ❑ DEMOLITION
❑ MULTI-FAMILY/UNITS ❑ RELOCATION
❑ COMMERCIAL
❑ INDUSTRIAL
O HOTEL/MOTEL/DORM/UNITS
wir OTHER 34 Xforsizr UBC OCCUPANCY GROUP
DESCRIPTION OF IMPROVEMENT:
SQUARE FOOTAGE R PRINCIPLE TYPE OF HEATING FUEL
MAIN FLOOR 6,16—gaaAtf(oil ❑ E C RI TY ❑ OIL
2ND FLOOR �/�J ❑ S ❑ GAS
3RD FLOOR ❑ T UMP ❑ OTHER
HTD BASEMENT
UNHTD BASEMENT
CARPORT PRINCIPLE TYPE OF FRAME
GARAGE DECKS X WOOD ❑ MASONRY
❑ MANUFACTURED ❑ OTHER
COMMERCIAL ❑ STRUCTURAL STEEL
INDUSTRIAL
OTHER
TOTAL VALUATION /
Er ��n( MAXIMUM HEIGHT
ESTIMATED COST oC
11/ �� 0 INSTALLED 19_
TYPE OF SEWAGE DISPOSAL: ❑ SEWER tNTjF�SYSTEM
�y�k// �` SEPTIC PERMIT NUMBER
TYPE OF WATER SUPPLY: PRIVATE ❑ DRILLED WELL OTHER
PUBLIC ❑ CITY OTHER: NAME
.EV PUD STATE I.D.
NUMBER OF EXISTING BEDROOMS NUMBER OF EXISTING BATHROOMS
NUMBER OF PROPOSED BEDROOMS NUMBER OF PROPOSED BATHROOMS
TOTAL NUMBER OF BEDROOMS TOTAL NUMBER OF BATHROOMS
IF WATERFRONT PROPERTY NAME OF ADJACENT BODY OF WATER Az,
BANK HEIGHT A/A SETBACK
FRONT SETBACK /5-0 SIDE SETBACKS S0 / 30 C2 REAR SETBACK /5O
SIGNATURE etCite '�'_",7 DATE 7 —/0— 414
APPLICANT NAME (PLEASE PRINT)•t�i!' ic- ARroSOIV
// FOR OFFICE USE ONLY
TYPE OF ACCESS RD
❑ Primary Arterial
❑ Secondary Arterial ❑ Collector ❑ Access
FOOTPRINT (incl decks over 30" from ground)
LOT COVERAGE (footprint divided by total
sq ft of property)
BASE FEE 6—e, 75
PLAN CHECK /d?` 43 RECEIPT #_
STATE SURCHARGE 4.50 DATE
RADON KIT - �
TOTAL yQ, g-ll CAS CHECK 6 L J
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