HomeMy WebLinkAboutBLD1987-00351 410— N E.
I. LOCATION: geographic name S W SIDE OF 0 DAD
FEET
N E I I--) < ( €1 I e (-Ail y ROAD
S W FROM INTERSECTION OF ROAD AND
other specibc location or landmark:. P r
LEGAL DESCRIPTION: Subdivision
Lot Block I O 02nl 1 t"
Tax Number Y.Section Section Township Range
(: I.I.TYPE AND COST OF BUILDING - •
TYPE OF IMPROVEMENT BUILDING TYPE
0 Single Family PUBLIC WORKS APPROVAL
❑New building ,
�Addition ❑Multi-Family Road Access Permit No.
` number of units
� 0 Alteration
0 Hotel,Motel, Dormitory Utility Permit No.
C\ \ Repair,replacement number of units
( � 0 Wrecking Mobile Home Emergency Services No.
❑Moving(relocation) ❑Other-Specify Street Width A'
❑Foundation only
•r,o-F (ver mob ire B:
. Additional Permits Required:
OWNERSHIP
❑Private (individual,corporation,
nonprofit institution,etc.)
❑Public(Federal,State or local goVt.) UBC OCCUPANCY GROUP:
COST Omit cents) Nonresidential- Describe in detail proposed use of buildings,e.g.,food
• Cost of improvement S 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 existingm building is being changed,enter proposed we. Q ! /�
' b. Plubing LR C) x I2. = LD 'T t *6 + Q 1 L� L,I.J
C. Heating,air conditioning
d. Other(elevator,etc) .
• TOTAL COST OF IMPROVEMENT S
.fi;`--" III.SELECTED CHARACTERISTICS OF BUILDING
r
s
- DIMENSIONS `.,
V PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL. *Number of Stories
Masonry(wall bearing) 0 Public or P " e.X t5t •Total square feet of floor area, F
Wood Frame gIndivid I (septic tank, tc.) all floors,based on exterior
dimensions
o Structural steel
TYPE OF WATER SUPPLY •Total land area,sq.ft. f
0 Reinforced concrete
f.;I Public or private company NUMBER OF OFF-STREETi•
Other-Specify
Individual*dstern) pgRKINGSPACES •
Enclosed --
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE • •
Outdoors -'
0 Gas
OOil RESIDENTIAL BUILDINGS ONLY
Number of bedrooms
Electricity
TYPE OF MECHANICAL
0 Full
Coal Number of �,
her-Specify bathrooms Partial 1
IV.IDENTIFICATION
Name Mailing Address—Number,street,city and State ZIP axle Tel.No. -
1. CI a c e nnn B u rl- n 1 Lin ,T hl i e Way PT ot c' 3(01') 3 PiJ-
'73 y '7 t.
z. i -
..
Contractor State License No.
•
f
3 '
Architect - i".
J . .
The owner of this building and the undersigned agree to conform to all applicable laws.
of applicant Address�L-e � �� � cal) I 30 - i:,
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT 1-
A fp?V�D BY,J 7 ` APPROVED 3Y APPROVED BY [1-:
JEFFERSOU =-.i - 7 4 >/E SHOt'EL I NE DEPT. PLANNING DEPT.
APPROVED :Y- PERMIT FEE ISSUE DATE RECEIPT MUMBER
II ) c SO 7--(.0 ••• -.7 02 Ei/ 9 . ,
BUILDING OFFICIAL 5� bO b
T/,e P,•nrrr). - Port To.wisend TO H 0 (0/30/87 l..
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w_ A/ /0 -77.7 ?, dP /zu
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APP '1E *
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