HomeMy WebLinkAboutBLD1987-00385 N E FEET
I. LOCATION: ceopraphic name
$W SIDE OF ROAD
N E ROAD
S W FROM INTERSECTION OF ROAD AND
*/)Zs LAKE R1�
other specific location or landmark:
EGAL D SCRIPTION: / A L,DWELL t)i y 5 T PCA1 A CL
C7`��✓`r " Lot Block Subdivision
�f Township Range
0 I 3'a Dig Tax Number r`Y Section Section
II.TYPE AND COST OF BUILDING-
TYPE OF IMPROVEMENT BUILDING TYPE
PUBLIC WORKS APPROVAL
Single Family
❑New building -
t,Addition i ID Multi-FamilyRoad Access Permit No.
number of units
❑Alteration 0 Hotel,Motel,Dormitory Utility Permit No.
❑Repair,replacement number of units
❑Wrecking 0 Mobile Home Emergency Services No.
❑Moving(relocation) ❑Other—Specify Street Width A:
❑Foundation only c./
CD �Tc exIS77 rr1 1/Y6 B:
/B 1Zooiw G 4/W 4-
` Additional Permits Required:
A,o1/776m D /� /Z XZO '�Zyo 1
OWNERSHIP
Private(individual,corporation,
nonprofit institution,etc.) 3
❑Public (Federal,State or local got/t.) UBC OCCUPANCY GROUP:
COST (Omit cents) Nonresidential— Describe in detail proposed use of buildings,e.g.,food
• Cost of impl uementbut n
•
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.
If use of existing building is being changed,enter proposed use.
a. Electrical 03
2t/c. . /iez3 Q 3 �Lf"�
b. Plumbing p.�u�
C. Heating,aireonditioninaIJ-R►�9
o+
d. Other(elevator,etc 7
• TOTAL COST OF IMPROVEMENT
5;x/ "7 ,PjLrJ/y
III.SELECTED CHARACTERISTICS OF BUILDING - l
r / DIMENSIONS
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL •Number of Stories 1W ,
y ❑Masonry(wall bearing) 0 Public or Private •Total square feet of floor area, c,3,4/
` Frame fidindividual (septic tank,etc.) all floors,based on exterior / _//
-.- dimensions n :�a:i•t _
Structural steel Z / r}
TYPE OF WATER SUPPLY •Total land area,sq.ft r f{ �
❑Reinforced concrete ❑Public or private company
OtE, her—Specify • NUMBER OF OFF-STREET
0 I�lndividual (well,cistern) PARKING SPACES
T Enclosed
t PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE Outdoors
c.._.� ❑Gas EX/377r+9
RESIDENTIAL BUILDINGS ONLY /r/CG✓
06 ❑Oil Number of bedrooms /
V DCoal riaty TYPE OF MECHANICAL
/��❑Coal Number of Full / /vEk. i
L�J Other—Specify 0 bathrooms Partial i1
i
-.i. •
IV. IDENTIFICATION -
Mailing Address—Number,street,city and State ZIP code TO.No.
Name r7 ,�/
( Co.E' 42..1� Gt 4 ^ 3Z.- /Yu iI .Ownerj
2. J 1
State License No. i
Contractor
f
3.
Architect I-.
The owner of this building and the undersigned agree to conform to all applicable lams.
Address Applrartion date
Ssgn+[ of a scant
I 2.2.0 G 168, [..4K� 4D.,CER wu - i.
PLANNING AREA
FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT 1-
APPROVE BY y APPROVED 3Y APPROVED BY
\--I in S�` 7 _Z p SHOPEL I NE DEPT . PLANNING DEPT.
F'PR•JEFFE3Z•8 ....• .lab DE
APPR� • B '
PERMIT FEE ISSUE DATE RECEIPT AMBER
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