HomeMy WebLinkAboutBLD1987-00096 0 _____ _ ___________ _ _ _ __
N E
'w SIDE GAF ki f 4 r, r ROAD FEET
1. LOCATION: ct•oyraphic name
S W FROM INTERSECTION OF ROAD ANDX(.7 g44 I FI`•L a ROAD
other apacilic location or landmark:
Ij .
LEGAL DESCRIIPTION: C..
Subdivision
a O -' Lot Block
✓c
ai 0 '/ 0 2, 0 Tax Number Y.Section Section Township Range
II.TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE PUBLIC WORKS APPROVAL
.12fNew building 0 Single Family _
❑Addition ❑Multi-Family number of units Read Access Permit No.
❑Alteration
0 Hotel,Motel, Dormitory Utility Permit No.
Repair,replacement number of units
0 Wrecking ❑Mobile Home Emergency Services No.
0 /
Moving(relocation) Other—Specify Street Width A:
0 Foundation only
5---IP k, (t.5 `--r3 b ('c ,,; B:
S`ra.ft kck Ls t NI'� ' lt
Additional Permits Required:
OWNERSHIP PaA.-T d.o Mb ✓cra • -
et:
14Private(individual,corporation,
nonprofit institution,etc.)
❑Public(Federal,State or local gov't.) UBC OCCUPANCY GROUP: _/
COST (Omit cents) Nonresidential— Describe in detail proposed use of buildings,e.g.,food
• Cost of improvement $
processing plant,machine shop,laundry building at hospital,elementary
To be installed but not included school,secondary school,college,parochial school,parking garage for
in the above cost department store,rental office building,office building at industrial plant.
a. Electrical If use of existing building�c ', is being changed,enter proposed use.
b. Plumbing I K( a ,...//. ao 0
c. air conditioningJC (�- _ V - S�
Heating, I / Gam- P �'•
� old {�f
d. Other(elevator,etc.) t-"I
• TOTAL COST OF IMPROVEMENT S
III.SELECTED CHARACTERISTICS OF BUILDING -
DIMENSIONS
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL .Number of Stories
Masonry(mall bearing) Q Public or Private •Total square feet of floor area,
,j,�jWood Frame Q Individual (septic tank,etc.) all floors,based on exterior I
T� dimensions ,/ .. % e
[Structural steel
TYPE OF WATER SUPPLY t•Total land area,sq.ft.
❑Reinforced concrete
o Public or private company
❑Other-Specify - NUMBER OF OFF-STREET i
❑Individual (well,cistern) PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE •
Outdoors .
❑Gas
❑Oil RESIDENTIAL BUILDINGS ONLY
Number of bedrooms
❑Electricity Number
OF MECHANICAL •
❑Coal Number of Fx4L
1.
❑Other—Specify tfathrooms Partial j
p
IV.IDENTIFICATION
Name Mailing Address—Number,street,city and State ZIP code Tel.No.
✓pt� .
t 5 ,-
Owner '.
I
2 i.
State License No.
Contractor
1
3
Architect x
The owner of this building and the undersigned agree to conform to all applicable laws.
Signart of applhont Address
Application date (
?k7, Al' Ji A_ ..,/ . K ry0.87Rt? - [-
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT j WATER DISTRICT 1-
APPROVED Y APPROVED 3Y c 0 APPROVED BY
(44 a�fp1Q` k
IALTH DEP-g SHO.,EL NE ..EPT pk�'-=-s--=-? PLAN N I NG DE'"T.
PPRJEF ISSUE DATE RECEIPT NUMBER
APPROV PERMIT FEE
-‘,
s�,�' 3=� --IQ 7 3a�
1 BUILDING OFFICIAL b 1.
SJ
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