HomeMy WebLinkAboutBLD1987-00352 IP.
I. LOCATION: prographic name S 1si SIDE OF ROA _ FEET
NE wCL/
S W FROM INTERSECTION OF ROAD AND ROAD
0
other specificlocation or landmark: .
LEGAL SCRIPTION: Block Subdivision
6i cuon Township - Range
144 "_-- c)&_ ./ i(k..)
Tax Number Y.Section-
II.TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY •
New building 0 Single Family 0 New County Resident
Addition 0 Multi-Family Is this structure to serve the residential
number of units lor commercial needs of those employed
❑Alteration
1at either the US.Na 0Hotel,Motel, Dormitory W i Trident or
P 0 Repair,replacement number of units Indian Island Facilities? .
0 Wrecking 0 Mobile Home
0 Moving(relocation) �Othe —Specify ,....____42:_iP0 YES ONO
D Foundation only ._
vl USE
OWNERSHIP 0 Full-time Residence
❑Private . ividual,corporation, 0 Second Horne:Recreation Cabin,etc.
no °fit institution,etc.)
ublic(Federal,State or local wit.) UBC OCCUPANCY GROUP: - 0 Second Home:Future conversion to
permanent residence
-
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,perking garage for
in the above cost department store,rental office building,office building at industrial plant.
a. Electrical If use of existing b - •ng is being changed,enter °posed use.
b. Plumbing
1� c. Heatin it conditioning l j
5 37�--F /i
v J d her(elevator,etc.) • 67 l 3776 r " - C q(00 - r
•
• TOTAL COST OF IMPROVEMENT $ 4 I
III.SELECTED CHARACTERISTICS OF BUILDING F
• DIMENSIONS •-..... '•-
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DI •Number of Stories
9 0 •Total square feet off
D Masonry(wall bearing) Public 'Private
- od Frame Indivio� l (septic tank etc.) all floors,based 'G
` � dimensio
Structural steel • C
TYPE OF WATER SUPPLY • tat land area,sq.fL 5/fJ
0 Reinforced concrete
0 Public or private company i
D Other—Specify NUMBER OF OFFSTRF_ET -_�— I
-- ❑Individual (well,cistern) �PARKING SPACES r
; :--
Dcclos -
PRINCIPAL TYPE OF HEATING FU TYPE OF FIREPLACE il —1ESIDENTIAL BUILDINGS ONLY
Number of bedrooms ;
0 Electrici
0 TYPE O ECHANICAL
Number of Fun I
Other—Specify bathes v
Palma'
IV. IDENTIFICATION-
Name Mailing Address—Number,street,city sand to ZIP code Tel.No.
1. COAD c9C05 -7' en.4-b2i 6. —6e;s7? .-.
Owner 4)lit J�. f)
F'
)
2' �' `
State License No.
Contractor - f
f-
Architect,
The owner of this building and the undersigned agree to oonforrn to all applicable laws.
Signaf f applicany/,..
/ ion dale
Addressiy, �[/�/_�� n
...... , _..,,le,.... _. '''\
PLANNING AREA FI E DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY plc/ OIL
I-• P.- O�''•e- 4 161 f
JEFFERS'J't COUNTY HEALTH DEPARTMEtri 2-1l�7 "
PERMIT FEE ISSUE DATE RECEIPT NUMBER
APPROVEDQ is
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,ILDINGOFFICI ' fD r C7CD_ _„---�
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APPROVED
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$1Z1, 1 8‘ — 36 ( d'
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