HomeMy WebLinkAboutBLD1987-00412 1111/ N E11111 t
I. LOCATION: prographicname S W SIDE OF ROAD - FEET
S W FROM INTERSECTION OF dd
ROAD AND gO E Y l l I le po-- ROAD
,4 r 4
other specific location or landmark:
, VLEGAL DESCRIPTION: I
ttiS,Cf Lot Block s6...� Subdivision
,) I (id
Tax Number Y.Section Section Township Range
IL TYPE AND COST OF BUILDING-
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY •
LJ 0 New building ❑Single Family - ❑New County Resident
Q0 Addition ❑Multi-Family Is this structure to serve the residential
number of units
0 Alteration or commercial needs of those employed ,
c' ❑Hotel,Motel,Dormitory at either the US.Navy's Trident or
�} ❑Repair,replacement number of units Indian Island Facilities?
0 Wrecking Mobile Home r
❑Moving(relocation) D Other—Specify ❑YES ONO i_
e
❑Foundation only
i-
USE
OWNERSHIP
0 Full-time Residence
0 Private(individual,corporation, D Second Home:Recreation Cabin,etc.
nonprofit institution,etc.) .
❑Public (Federal,State or local govt.) UBC OCCUPANCY GBOUP: li.-3 0 Second Home:Future conversion to f,'
permanent residence r.
COST (Omit cents) Nonresidential— Describe in detail proposed use of buildings, •g•a .food t'
• Cost of improvement $ processing plant,machine shop,laundry building at hospital,elementary r
t To be installed but not included school,secondary school,college,parochial school,parking garage for
�J 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.
F/_
b. Plumbing 1 a4(i t.
Qc. Heating,air conditioning ,
`\ b'
:-° d. Other(elevator,etc.)
or • TOTAL COST OF IMPROVEMENT $
�J III.SELECTED CHARACTERISTICS OF BUILDING - A'
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DIS (in
us-, DIMENSIONS a`,-
ID (wall bearing) D Public or Private •Number of Stories %zr
•Total square feet of floor area,
.,�j 0 Wood Frame lndividua (septic tank etc.) all floors,based on exterior
` ) Structural steel dimensions _•
TYPE OF WATER SUPPLY •Total land area, ft. j'
0 Reinforced concrete sq. i
Other—Spec fy D Public or private company
)ZrIndividual (well,cistern) NUMBER OF OFF-STREET ( -
MatO cfc, f-ec� PARKING SPACES I
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE ii''..
D Gas Outdoors
DOH RESIDENTIAL BUILDINGS ONLY }J
❑Electricity Number of bedrooms
DCoal TYPE OF MECHANICAL
Number of Full
D Other—Specify bathrooms ''r
- Partial 4;
IV- IDENTIFICATION- - -
Name Mailing Address—Number,street,city and State ZIP code Tel.No. ';is
1 ( n/ 3atah 6(5c I Q 1 35g —(o 30
J No2i�3ss.5- r;-
2.
Contractor State License No.
a - s' a
Architect
r.74:1'1':1
1 •
The owner of this building and the undersigned agree to conform to all applicable laws.
Signature of atairlia., Lod Address Application date „...
1 4/ 7tri1E-- 4-- .('-kx)p-e__ i-) 3---K7 ,
Jr. _
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY j -
JEF N DEPART ENT • <
APPROVED PERMIT FEE ISSUE DATE RECEIPT NUMBER '' I'
, , s—c) 3-1(i--E7 (p 303 „.;,:-;,--
BUILDING OFFICIAL `----
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