HomeMy WebLinkAboutBLD1987-00386 --
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I. LOCATION: prographic name S W SIDE OF /)jam J ROAD FEET
N E �`1 l l d 1 r 1k. Privh ROAD
S W FROM INTERSECTION OF ROAD AND 1
other specific location or landmark:
LEGA DESCRIPTION: Subdivision
�— Block
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OQI 3-2. l Section Township Range
r 7ax Number Y.Section
II.TYPE AND COST OF B ILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY •
❑New building ❑Single Family - 0 New County Resident
Addition ❑Multi-Family Is this structure to serve the residential
14;,,, number of units or commercial needs of those employed
['Alteration'CO 0 Hotel,Motel, DormitoryNavy's Trident or
Repair,replacement at either the US.
number of units Indian Island Facilities?
IC Wrecking ��❑Mobile Home
y 0 Moving(relocation) ;; Other—Specify 0 YES ONO
i' Foundation only �� • r
USE
OWNERSHIP CD Full-time Residence
0 Private(individual,corporation, 0 Second Home:Recreation Cabin,etc.
nonprofitinstitution,etc.) n 3 m
❑Public(Federal,State or local gov't.) UBC OCCUPANCY GROUP: /2 " 0 Second Hoe:Future conversion to
cosT
permanent residence
. ...Z.:2
(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,parking garage for
in the above cost department store,rental office building,office building at industrial plant.
a. Electrical If use of existing building is being changed,enter proposed use.
b. Plumbing
c. Heating,air conditioning
d. Other(elevator,etc.)
•
• TOTAL COST OF IMPROVEMENT $ e -
III.SELECTED CHARACTERISTICS OF BUILDING -
- DIMENSIONS s
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL 'Number of Stories
0 Masonry(wall bearing) 0 Public or Private •Total square feet of floor area,
0 Wood Frame 0 Individual (septic tank,etc.) all floors,based on exterior
dimensions ;
O Structural steel
TYPE OF WATER SUPPLY •Total land area,sq.ft. /(_ s
❑Reinforced concrete I i�'
0 I
Public or private company
❑Other—Specify - NUMBER OF OFF-STREET 1
0 Individual (well,cistern) PARKING SPACES c
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE i.
Outdoors
i
0 Gas t
•
0 Oil RESIDENTIAL BUILDINGS ONLY
Number of bedrooms ;
0 Electricity
TYPE OF MECHANICAL
0 Coal - Full !!
Number of t,
0 Other—Specify bathrooms Partial V
IV.IDENTIFICATION- -
Name ] Mailing Address—Number,street,city and State ZIP code Tel.No.
r
I. .f f-
f
,,,,„7 0 150C jo 'l � � t:
/ sate License No.
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a
Architect - _
The owner of this building and the undersigned agree to conform to all applicable laws.
AC I /�/� //�ADVl�tion datei
S ?leofapdf�'�nt (�1Address -� /�1 V l
74
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT -
APPROVED BY
JEF i CDCJN't' HEALTH DEPAR J I"(T
APPROVED Y: PERMIT FEE ISSUE DATE RECEIPT NUMBER
,;A d � O
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BUILDING OFFICIAL l 5--°
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