HomeMy WebLinkAboutBLD1987-00354 t
Pt It P t t V N E
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geographic name S W SIDE OF" ROAD � 1 FEET
rE S 2 5 1987 S W FROM INTERSECTION OF ROAD AND 00 Ct ' R AD
PLAN 41NO Dlianatiolocation or landmark: l
i €tCrtIPTION: 4liwAil ( u n 3 w.L /a 3t-ti.,6s z�
V�IX._ 00 1 O7/Op Lot Block Subdivision / ��
P 3U&) /�
Tax Number Y.Section Section Township Range
II.TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILIT •
Y
)Ersfiew building Single Family • ❑New County Resident
- 0 Addition El Multi-Family number of units Is this structure to serve the residential
0 Alteration or commercial needs of those employed
❑Repair,replacement ElHotel,Motel, Dormitory at either the US.Navy's Trident or
number of units Indian Island Facilities?
Cr 0 Wrecking
0 Mobile Home
' 0 Moving(relocation) 0 Other—Specify
(\v`, 0 Foundation only ❑YES �O
USE
OWNERSHIP
❑Full-time Residence
❑Private(individual,corporation,
nonprofit institution,etc.) ❑Second Home:Recreation Cabin;etc.
❑Public(Federal,State or local gov't.) UBC OCCUPANCY GROUP: /- — 0 Second Home:Futureconversion to
permaneru residence
COST (Omit cents) Nonresidential— Describe in detail ro p posed use of buildings,e.g.,food
• Cost of improvement $ processing plant,machine shop,laundry buildingat 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,offibe building at industrial plant.
t a. Electrical If use of existing building is being changed,enter proposed use.
b. Plumbing QC 0'D �i�C
•
Heating,air conditioning 9 'S— -- �/7��------ 7 I' W
d. Other(elevator,etc.) 6-- -
• TOTAL COST OF IMPROVEMENT $•
�� F`{
III.SELECTED CHARACTERISTICS OF BUILDING
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS .•
ElMasonry(wall bearing) LiPublic or Private
i •Number of Stories
� ,{ •Total square feet of floor area,
ood Fame Individual etc.) all floors,based on exterior °
❑Structural steel dimensions `-
I -
TYPE OF WATER SUPPLY Total land area,sq.ft.
❑Reinforced concrete •
❑Other—Specify
❑Public or private company
NUMBER OF OFF-STREET
❑Individual (well,cistern) PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY
Electricity Number of bedrooms i': K.
❑Coal • TYPE OF MECHANICAL f. • `
Number of Full
her—Spe 'fy �
bathrooms
Partial
r.
IV. IDENTIFICATION- •
Name Mailing Address— Number,street,city and State ZIP code Tel.No.
t. 1�rn 5±zimmer~ lab ) i7 i , ggNag ,335=,333 r
`2 Ici rl Der'.Gda l 4) ,T1
2. 12i C) t I.J IJIV c P T L(
Contractor State License No.
3. t
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Signatu of applicanti\s,...
a. .2--- ---------e-______ Address
1 Application date
-
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY J ['
7 _`_ I. P fCHE f / _a
JEF COUNTY HEALTH DEPAi NT -
APPROVED A' PERMIT FEE ISSUE DATE RECEIPT NUMBER i
0.0
, 5 t w C�0Z/a7/g 7 (''.2 (0 it/7
BUILDING OFFICIAL /, S�
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