Building DescriptionDISTANCE BUILDING WILL BE FROM PROPERTY LINES
FRONT P.L. OR CENTER LINE OE REAR: - SIDE SIDE;
ROAD: --
OF GARAGE BAYS: ' VERSIZE TUB (>50 GALS):
NO, OF FLOORS: NO. OF BEDROOMS: N0. DISPOSAL: :�� O
SQUARE FOOTAGE
f
1st FLOOR:111224
2nd FLOOR;
3rd FLOOR:
JOB ADDRESS:
LEGAL Subdivision:`
Lot: _
—Block:
UNFINISHED ACCESSORY:
_
GARAGE: /> /
GRAIN BIN DIAMETER: -
OWNER: 1 tl
�i e, y4 ,!! L
— -
--------
CURRENT ADDRESS:
Val—
CITY:
CITY:
__ STATE: ZIP:
PHONE NUMBER:'"
1
JCT RS
RA
e� �iJ
-
GENERAL CONTRACTOR: �J
_
-
ADDRESS:
CITY:
STATE: — ZIP:
PHONE:FAX:
,-
CELL:
_ ---
EMAIL:
-----—
----
ELECTRICAL_:
_
PHONE: _
-
MECHANICAL:
----PHONE:
--
PLUMBING:
_PHONE:
_ -
SEPTIC:
_--_
PHONE:
PROJECT DESCRIPTION (Circle
One)
NEW RESIDENCE ADDITION
REMODEL ACCESSORY
DECK
POOL �— GRAIN BIN
DISTANCE BUILDING WILL BE FROM PROPERTY LINES
FRONT P.L. OR CENTER LINE OE REAR: - SIDE SIDE;
ROAD: --
OF GARAGE BAYS: ' VERSIZE TUB (>50 GALS):
NO, OF FLOORS: NO. OF BEDROOMS: N0. DISPOSAL: :�� O
SQUARE FOOTAGE
f
1st FLOOR:111224
2nd FLOOR;
3rd FLOOR:
FINISHED BASEMENT: �}�
UNFINISHED BASEMENT: -- --
FINISHED ACCESSORY:
UNFINISHED ACCESSORY:
DECK/PATIO/PORCH(S) (Total of all):
GARAGE: /> /
GRAIN BIN DIAMETER: -
I -
APPROXIMATELY CONSTRUCTION START DATE: / I —12 -20Z(O END DATE: —
'
The above requested information is, to the best of my knowledge, true and accurate. It is understood and agreed that any error, misstatement or
misrepresentation of fact, either with or without intention on my part, such as might if known, cause a refusal of this application or any alteration
or change in plans made without the approval of the Planning and Zoning Administrator subsequent to the issuance of the building permit shall
constitute sufficient grounds for the revocation of such permits.
By this signature, the Planning and Zoning Ad inistr r, or authorized representative of Washington County Is authorized to enter upon the
property described fori• se of inspec - 4 `% //� j l
SIGNED: - __._�-- � _ --
DATE: L' ` + ' G �l ---