HomeMy WebLinkAboutBLD1987-00417 3__— N E
— --- zOAD
I. LOCATION: propraphic name SW SIDE OF_, FE T
NE �?
S W FROM INTERSECTION OF ROAD AND
other specific location or landmark:
LEGAL D CRIPTION: 7� `Block Sr
iuo
c�� � _ Lot 3`-{ 30 I.)
\5� 7OO Tax Number Y.Section Section Township Range
II./ TYPE AND COST OF BUILDING-
TYPE OF IMPROVEMENT BUILD NG TYPE
PUBLIC WORKS APPROVAL
Nevwbuilding Single Family
❑Addition 0 Multi-Family Road Access Permit No.
number of units
❑Alteration D Hotel,Motel,Dormitory Utility Permit No.
0Repair,replacement number of units •
O Wrecking 0 Mobile Home Emergency Services No.
Moving(relocation) ❑Other—Specify Street Width A:
0 Foundation only
• B:
. Additional Permits Required:
OWNERSHIP
❑Private(individual,corporation,
nonprofit institution,etc.)
❑Public (Federal,State or local go✓t.) UBC OCCUPANCY GROUP:
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
• 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 building is being changed,enter proposaluse.
,
b. Plumbing. �/l/1 /J C�Dfti c _ `
1 (•/t. Oe, — - 1 Y I e/V 3,..5
G Heating,air conditioning
-c-' d, Other(elevator,etc 1 .
�
v'( • TOTAL COST OF IMPROVEMENT IS
III.SELECTED CHARACTERISTICS OF BUILDING -
t c MENSIONS / 9'
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPO , f ',Number of Stories
Masonry(wall bearing) ❑Public or Privy�--� •Total square feet of floor area,
�s..,. all floors,based on exterior�p"j Wood Frame -I (septic tan I etc.).. I `D1 J dimensions_
�►J Structural steel
TYPE OF WATER SUPPLY *Total land area,sq.ft.
ReinforcedCO 0 concrete 0 Public or private company ,
Other—Specify NUMBER OF OFF-STREET
0 Individual (well,cistern) PARKING SPACES :
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE Outdoors ...
Gas
Oil f r- RESIDENTIAL BUILDINGS ONLY
�Z Number of bedrooms
ElectricityC TYPE OF MECHANICAL
❑Coal Nurnber of Full.
s❑Other—Specify bathrooms Partial I
It
IV. IDENTIFICATION
Name Mailing Address—Number,street,city and State ZIP code Tel.No.
On U 11-r, filar v,ii k) l 61 0 , . h -- v ..� . — co
Droner /
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2.
M
Contracto �� C. Lc.e YC F
k ( 1 f.
. 3-
Architect - _
The owner of this building and the undersigned agree to conform to all applicable laws.,.
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Address Asiolocation dais
`
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVE?B APPROVED 3`; APPROVED BY
JEFFERSON 1
F[EAL DEP' SHO:/,..,,,-c,
e-L 1 NE DEPT. PLANNING
APPROVED BY / PERMIT FEE ISSUE DATE RECEIPT NUMBER
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