HomeMy WebLinkAboutBLD1987-00362 N E.
S W SIDE OF III ROADJ — FEET
I. LOCATION: pcopraphic nerve --ilf N Ems/ / .,/L?-CCU,-E� ROAD
S W FROM INTERSECTION OF ROAD AND
or speci
fic ific location or landmark:
LEGAL DE CRI ION: /- -/ Block Subdivision
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C ( G' VV 70 7 Tax Number Y.Section Section Township Range
II.TYPE AND COST OF BUILDING-
TYPE F IMPROVEMENT
TYPE TYPE
PUBLIC WORKS APPROVAL
New building ❑Single Family
Addition ❑Multi-Family number of units Road Access Permit No.
❑Alteration ❑Hotel,Motel,Dormitory Utility Permit No.
Repair,replacement number of units
❑Wrecking 0 Mobile Home Emergency Services No.
❑Moving(relocation) Other ufy Street Width A-
❑Foundation only
B:
(--_-?ora, _........ Additional Permits Required:
OWNERSHIP
❑Private(individual,corporation,
nonprofit institution,etc.)
❑Public(Federal,State or local go✓t.) UBC OCCUPANCY GBOUP:
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 I To be installed but not included school,secondary school,college,parochial school,parking garage for
in the above cost department store,rental fice building,office building at industrial plant.
If use of existin build. is being changed,enter proposed use.
�- a. Electrical � .-- �` �
T /ll,�� CD
�•
{G�z--- b. Plurrbing
`; c. Heating,air conditioning
d. Other(elevator,etc.)
• TOTAL COST OF IMPROVEMENT S
III.SELECTED CHARACTERISTICS OF BUILDING
DIMENSIONS
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL •Number of Stories
❑Masonry(wall bearing) 0 Public or Private �/ •Total square feet of floor area,
Wood Frame 0 Individual (sepysta c nk,etc.) all floors,based on exterior '�
/ dimensions
Structural steel
TYPE OF ER SUPPLY / `.
•Total brad area,sq.ft ,.• i-
❑Reinforced concrete ublic or private company
❑Other—Specify • NUMBER OF OFF-STREET
•
•/ 0 Individual (well,cistern) PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL) TYPE OF FIREPLACE
❑Gas Outdoors
❑Oil RESIDENT L BUILDINGS ONLY
Nu r of bedrooms
❑EleRrici TYPE OF MECHANICAL i'-
❑ �'Nucstber of Full ... b
Other—Specify bathrooms Partial E
— 7
IV.IDENTIFICATION r;
Name Mailing Address—Number,street,city and State ZIP code Tel.No.
33� -- i.
Ow*Kr �1 C /G'11 fl,--)Azylic
,,_ rt
2 State License No.
Contractor
3.
Architect ,
The owner of this building and the undersigned agree to conform to all applicable laws. .
Add Aa i i date
S ura of applicant • \��
p,� /� S '� //( i� /
f/i 7 / l ✓t 6 'L �> ilk/ll `Q �..
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY APPROVED 3Y APPROVED BY
r 3
JEFFFRS i lvrY HEALTH DEP' : SHOPEL I NE DEPT. PLANNING DEPT.
APPROVED BY: PERT FEE ISSUE DATE RECE IPT MJMBER
CiPLJ r
c6D CZ
BUILDING OFFICIAL `s _
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