HomeMy WebLinkAboutBLD1987-00406 _ill
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I. LOCATION: peopraphic name S W SIDE OF JOAD FEET
S W FROM INTERSECTION OF ,_ROAD AND - /CD in /---U1�1-. ROAD
H 4
other specific location or landmark: (� ��
LE AL DESCRIPTION: //7 ( 72 �,�G�l/v(�}'� ,/
rL �� �w G�
/ 07 c2 17 Tax Number Y.Section Section Township Range
II.TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY •
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
❑Repair,replacement ElHotel,Motel, Dormitory at either the US.Navy's Trident or
number of units Indian Island Facilities?
0 Wrecking /Mobile Home
❑Moving(relocation) L�J Other-Specify ❑YES ONO
❑Foundation only )
G L' Aal W LAW-,c-r-- e x\41,-ty
2s-1` X1-4.t -tt.pU IZ , 1 USE
OWNERSHIP
0 Full-time Residence
❑Private (individual,corporation,
C nonprofit institution,etc.) ❑Second Home:Recreation Cabin,etc.
s,`,,•,.J ❑Public(Federal,State or local goVt.) UBC OCCUPANCY GROUP: El Second Home:Future conversion to
-. permanent residence -
\ COS (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 F
in the above cost department store,rental office building,office building at industrial plant. i,
Ca. Electrical If use of existing building is being changed,enter proposed use.
b. Plumbing ____ ag . a
c. Heating,air conditioning "`���ddd t!
. "a
d. Other(elevator,etc)
• TOTAL COST OF IMPROVEMENT $
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DI Ste)` DIME IONS �+'IM-
❑Masonry(wall bearing) P blic or Pnva a // umber of Stories
p-c
•Total square feet of floor area, I--
Q ❑Wood Frame l ivid 1 (septic to . all floors,based on exterior
❑Structural steel dimensions
o Reinforced concrete TYPE OF WATER SUPPLY •Total land area,sq.ft. ; ---
❑Public or private company F
lErilptb,er-S ey NUMBER OF OFF-STREET
'— / 0 Individual (well,cistern) PARKING SPACES
UU l � Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
❑ it RESIDENTIAL BUILDINGS ONLY .
Electricity Number of bedrooms 1" }
❑Coal TYPE OF MECHANICAL
Full I---
Number of I
A • her-Spe bathrooms Portia! k
•
IV.IDENTIFICATION- •
`
f ,.'
N me Mailing Address-Number,street,city and State ZIP code Tel.No.
1.
Owner - l�XX 2 7J d ntt oy 4 e /cb�.33 9 lL 37
2.
Contractor State License No.
. 3 -
Architect i- -
The owner of this building and the undersigned agree to conform to all applicable laws. '
_ ttat of a icant ' 664,17e--t-....._
Add` /fAODI�jtion J
ir9_/
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT '
APPROVED BY HID q_A7_�
JEFFERSON COUNTY 77i DEPARTMENT
APPROV B ' PERMIT FEE ISSUE DATE RECEIPT NUMBER
75 / 00
q _ c7—K7 -
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