HomeMy WebLinkAboutBLD1987-004051 __ _ , ,
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I. LOCATION: geographicnae S W SIDE OF
m •ROAD `�� FEET
S W FROM INTERSECTION OF ROAD AND I' '`� —' I' ' "'U"�- ` ROAD
other specific location or landmark: / 1
LEGAL DE RIPTION: 7 3 � �d al� ,` '_ I
C /� 2 (`� Block � . / Subdivision I LJA /1
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IlA I J vV Tax Number Y.Section Section Township Range
II.TYPE AND COST OF BUILDING •
-
TYPE OF IMPROVEMENT BUILDING TYPE
New building
0 Single Family PUBLIC WORKS APPROVAL
\of,
0 Addition ❑Multi-Family
number of units Road Access Permit No.
❑Alteral o r
❑Hotel,Motel, Dormitory Utility Permit No.
Repai , eplacement - number of units
❑wrecking obile Home Emergency Services No.
0 Moving(relocation) Other—Specify Street Width A:
g 0 Foundation only A:
B:
Additional Permits Required:
cE—'', OWNERSHIP
• W 0 Private(individual,corporation,
nonprofit institution,etc.) 2
❑Public(Federal.State or local gov't.) UBC OCCUPANCY GEBOUP: , /2!3
1 COST (Omitcentsl Nonresidential— Describe in detail proposed use of buildings,e.g.,food
• Cost of improvement $ processing plant,machine shop,laundry building at hospital,elementary
J •
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.
`�.i' If use of existing building is being changed,enter proposed use.
``/'� a. Electrical
�/ b. Plumbing Ica Co L/
C. Heating,air conditioning H• / '/I Yo
d. Other(elevator,etc.) ( `� Q
• TOTAL COST OF IMPROVEMENT S
III.SELECTED CHARACTERISTICS OF BUILDING - 1
DIMENSIONS e{
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL •Number of Stories..
Masonry(wall bearing) Q Public or Private •Total square feet of floor area,
0 Wood Frame Individual ptic tank tc.) all floors,based on exterior
`�. dimensions
O Structural steel
TYPE OF WATER SUPPLY •Total land area,sq.ft. �;
Reinforced concrete
1 �} �Public or private company
her—Specify \lXn �n1/ NUMBER OF OFF-STREET r� ^ Q Individual (well,cistern) PARKING SPACES .
l l�/I t Enclosed .
PRINCIPAL TYPE OF EATING FUEL TYPE OF FIREPLACE
ElOutdoors --
Gas
(] it RESIDENTIAL BUILDINGS ONLY •
�,(� Number of bedrooms ��
D Electricity
(]Coal TYPE OF MECHANICAL
Number of ull '
F
her^S,pef bathrooms Part
IV. IDENTIFICATION
Name Mailing Address—Number,street,city and State ZIP code Tel.No..... ., .-
Owner `
Contractor State License No.
I
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3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Address AQNt oIt \ '� - to 1 .
'LANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
�QCED 9Y_Li` ! /n APPROVED 3`; APPROVED BY
I /ll / Up.� SHOr'ELINE DEPT. PLANNING DEPT.fEFFERSON COUNTY t�A.LTH DE_ '!
'PRO E BY: � ERMIT FEE ISSUE DATE RECEIPT NUMBER
(i) — L4'AS".7 .
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