HomeMy WebLinkAboutBLD1987-00404 —
6 N E ' •
I. LOCATION: geographic name _ S W SIDE OF g ROAD(� �-p n FEET
S W FROM INTERSECTION OF ROAD AN D `'L `��-- ROAD
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other specific location or landmark: t
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LEGAL ESCRIPTION: r /
nay/� Lot lock Subdivision
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Tax Number Y.Section Sectio Township ge
II.TYPE AND COST OF B ILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY •
1New building ❑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? .
0 Wrecking
obile Home
❑Moving(relocation) 0 Other—Specify 0 YES ONO
❑Foundation only
•
USE
OWNERSHIP 0 Full-time Residence
❑Private(individual,corporation,
nonprofit institution,etc.) Second Home:Recreation Cabin,etc.
0 Public(Federal,State or local gov't.) UBC OCCUPANCY GROUP: J2.-- - ❑Second Home:Future conversion to
permanent residence
.3 COST (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
a 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 buildingil- is being changed,d,enter proposed use.
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b. Plumbing gy , ` l / 3
�I, . e. Heating,air conditioning
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d. Other(elevator,etc.)
• TOTAL COST OF IMPROVEMENT $
--- III.SELECTED CHARACTERISTICS OF BUILDING - F.
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PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
•Number of Stories
0 Masonry(wall bearing) ❑Public or Private •Total square feet of floor area,
.�j 0 Wood Frame ❑Individual (septic tank,etc.) all floors,based on exterior
dimensions
•
❑Reinforced concrete
❑Structural steel
TYPE OF WATER SUPPLY •Total land area,sq.ft-
❑Public or private company
lid9ther—Specify NUMBER OF OFF-STREET
�y ar A ❑Individual (well,cistern) PARKING SPACES
l� Enclosed
PRINCIPAL TYPE fly
FUEL TYPE OF FIREPLACE
❑Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY
❑Electricity Number of bedrooms ,
TYPE OF MECHANICAL
•---'
❑Coal • Number of Full
❑Other—Specify bathrooms V /
- Partial
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IV.IDENTIFICATION- - •_ t
Name Mailing Address—Number,street,city and State /; ZIP code Tel.No.
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Owner
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Contractor State License No.
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Architect F-
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The owner of this building and the undersigned agree to conform to ail applicable laws.
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(fiognatureofapplicant J ctiondste
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PLANNING AREA z._FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY < - J f-I ' l
JEFFERSON i T DEr" NT -
APPROVED BY(' 4 • PERMIT FEE ISSUE DATE RECE/PT NUMBER
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