HomeMy WebLinkAboutBLD1987-00348 inillill
VE aI. LOCATION: peopraphicname S W SIDE OF ROAD
+ FEET
N E
S W FROM INTERSECTION OF ,l RC3AD AND / C/ q( �y-I e Q L �� l LQJ ROAD
Y
other specific location or landmark: y
LEGAL DESCRIPTION: 7 C(�I5 5'`� t,u s,e /)
t Lot Block Subdiv" n
C f I 33 100,2q Tax Number Y.Section Section Township Range
II.TYPE AND COST OF BUILDING-
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
•
❑New building ❑Single Family ❑New County Resident i
❑Addition ❑Multi-Family
Is this structure to serve the residential
❑Alteration number of units or commercial needs of those employed
0 Repair,replacement ❑Hotel,Motel, Dormitory at either the US.Navy's Trident or
number of units Indian Island Facilities?
❑Wrecking
,Mobile Home
❑Moving(relocation)
❑Other—Specify LI
❑Foundation only YES ONO
OWNERSHIP USE
Full-time Residence❑Private (individual,corporation,
nonprofit institution,etc.) 0 Second Home:Recreation Cabin,etc.
Ili 44. 0 Public(Federal,State or local gov't.) UBC OCCUPANCY GROUP: '2 30 Second Home:Future conversion to
permanent residence
coST (Omit cents)
J • Cost of improvement
Nonresidential— Describe in detail proposed use of buildings,e.g.,food
$ 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.
\�,J\ a. Electrical If use of existing building is being changed,enter proposed use.
b. Plumbing le `c0
t, ..
r c. Heating,air conditioning
a d. Other(elevator,etc.) c
.-
c" • TOTAL COST OF IMPROVEMENT $
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS __'
_,` Masonry (wall bearing) •Number of Stories
Public or Private
Wood Frame •Total square feet of floor area,
❑Individual (septic tank,etc.) all floors,based on exterior
Structural steel dimensions
❑Reinforced concrete TYPE OF WATER SUPPLY •Total land area, ft. /
Other—Spec" Public or private company ")
Individual (well,cistern) NUMBER OF OFF-STREET ' /
PARKING SPACES
PRINCIPAL TYPE F HEATING FUEL Enclosed
TYPE OF FIREPLACE
❑Gas Outdoors
El
OBI RESIDENTIAL BUILDINGS ONLY ti r,r
Electricity Number of bedrooms a
TYPE OF MECHANICAL ID Coal i
O Other—Specify Number of Full /
11
bathrooms
Partial
IV. IDENTIFICATION- -
•
Name Mailing Address—Number,street,city and State ZIP code '
Tel_No.
1. �. ' ! ,._ / III4...r // J , 3 _ rY
Owner
2.
Contralto State License No. 1
3.
Architect
•
The owner of this building and the undersigned agree to conform to all applicable laws.
Signature applicant / / Address {'
/J z/ -,,J) Application date ( ,I .
5c +'� -
•
PLANNING AREA
APPROVED BY FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
JEFFEFtSOf'�/\COUNTY HEALTH DEPARTMENT .
1:::::::-;1:3-`
3
k
APPROVED Blfs0._ •
t_.
II!! PERMIT FEE ISSUE DATE
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:IR:CE 1 PT NUMBER1",:::
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