HomeMy WebLinkAboutBLD1987-00396 ID
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I. LOCATION: geographic name S W SIDE OF WOAD FEET
N E • �/j/}
S W FROM INTERSECTION OF ROAD AND 1Jt I C ,�P ROAD
H
other specific location or landmark:
LEGAL D CRIPTION: �
/•-•-•„) L_____
Lot —Bruck / V
Co Subdivision �_.
s�
791( y V f� 0 Tax Number y.Section Sect n Township Range
II.TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT B LDI G TYPE MOBILITY •
New building l Single Family 0 New County Resident
Addition ❑Multi-Family Is this structure to serve the residential
number of units❑Alteration or commercial needs of those employed
❑Hotel,Motel,Dormitory at either the US_Navy's Trident or
❑Repair,replacement number of units Indian Island Facilities? •
Wrecking ❑Mobile Home
Moving(relocation) O Other-Specify 0 YES ONO
❑Foundation only
USE
OWNERSHIP 0 Full-time Residence
❑Private(individual,corporation, ❑Second Home•Recreation Cabin,etc.
nonprofit institution,etc.) f�,
0 Public (Federal,State or local goV r'��t.) UBC OCCUPANCY GROUP: -✓ 0 Second Home:Future conversion to
.. permanent residence
(Omitcentsl Nonresidential- Describe in detail proposed use of buildings, ood
, 9, e.g.,A•
• 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.
If use of existing building is being changed,enter proposed use.
a. Electrical E0 740 __
ng
`� b. Plumbing __.v a / 1{�� - 00411Pi
a!
C. Heating,air conditioning " ^ t 'eft7: ! VI NF,
_.: - ern �; !2t7'3 (c/�y�",
• d. Other(elevator,etc.) ill,,. , )L Je it \ 33 e, /I
•
• TOTAL COST OF IMPROVEMENT $ •ft.'
i C� 3 -- G ` "C
- b' ( ) C (1 ei \x)\
.,.,,„ III.SELECTED CHARACTERISTICS OF BUILDING /174-/ 6) a �_i
/
'7.,f Ex
,`a :' DI2 .:
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL �e
-
•Number of Stories
[]Masonry(wall bearing) Public or Private !squarefeet
•Tcta .__.of floor area,
Wood Frame Individual (septic tank,etc.) all floors,based on exterior
dimensions
O Structural steel
TYPE OF WATER SUPPLY •Total land area,sq.ft.
❑Reinforced concrete
0 Public or private company
❑Other-Specify NUMBER OF OFF-STREET
❑Individual (well,cistern) PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
•
o Gas Outdoors -.
DOi0 RESIDENTIAL BUILDINGS ONLY
❑Electricity Number of bedrooms
Coal TYPE OF MECHANICAL
Full
/p � Number of �
T> �O/th -Specify I1�/ bathrooms
VF- _'i'1« _ Partial
IV. IDENTIFICATION- •
Name Mailing Address-Number,street,city and State ZIP code Tel.No. k
1_ d7'e f/_c) q ii �_ I yott. / -C�%nS�-- n.3 . �, 7-2�
Owner
P(_ ._, t
2. C .
Contractor State License No.
I
Architect I
1
The owner of this building and the undersigned agree to conform to all applicable laws.
Signatu----T'`"4re of ap(iltcant �7 UI
../e.PLA I�NING AREA FIRE DI SCHOOL DISTRICT WATER DISTRICTI.
APPROVED BY 1 kpc. _ ,i'ys�
1 -
o buaW .tN."C"4 - r _
JEFFERZON HEALTH DEPARTMENT
APPROVED BY: '!t ` 37 /E FEE ISSUE DATE RECEIPT NUMBER
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