HomeMy WebLinkAboutBLD1987-00423 E • . _
I. LOCATION: yeopraphicmune S W SIDE OF
N E (�(�ID moo() �.�,,, �//� FEET
S W FROM INTERSECTION OF ROAD AND 1 t oo( , (241 \d t2
ROAD
other specific location or landmark: PaAi CI 7
4
aLEGAL DESCRIPTION: / I t /zaf,„,,y,' .....› ,
cre Block Subdivision
I COI /aj Tax Number ��� /s V (� /
Y.SectionSection Township
II.TYPE AND COST OF BUILDING- �n"�
TYPE OF IMPROVEMENT BUILDING TYPE
MOBILITY •
New building 0 Single Family
❑Addition ❑New County Resident
❑Multi-Family Is this structure to serve the residential
❑Alteration number of units
Hotel, or commercial needs of those employed
0 Motel, Dormitory at either the U.S.Navy's Trident or
❑Repair,replacement
❑Wrecking number of units
Indian Island Facilities)
0 Mobile Home
❑Moving(relocation)
Other-Specify
❑Foundation only $ 1 ad z__. - ❑YES ONO
*L
OWNERSHIP USE
❑Private(individual,corporation, ❑Full-time Residence
nonprofit institution,etc.) ❑Second Home:Recreation Cabin,etc. �''
0 Public(Federal,State or local go✓t,) UBC OCCUPANCY GROUP:
x 0 Second Home:Future conversion to
COST permanent residence E `
(Omit cents)
• Cost of improvementNonresidential- Describe in detail proposed use of buildings,e.g.,food i.
processing plant,machine shop,laundry building at hospital,elementaryTo be installed but not included school,secondary school,colle
in the above cost 9e.Parochial school,parking garage for•
.+ department store,rental office buildin office building at industrial plant. I-
t�, a. Electrical If use of existing building is being Chan d,enter r w
t"`• P oPosed use. Cb. Plumbing F(47
1(0 X 3 P � sl - ,3 - z./0 F6 Fri
— c Heating,air conditioning
d. Other(elevator,etc)
•
• TOTAL COST OF IMPROVEMENTIS
III.SELECTED CHARACTERISTICS OF BUILDING-
PRINCIPAL TYPE OF FRAME IMENSIONS Y�
TYPE OF SEWAGE DISPOSAL
❑Masonry(wall bearing) 0 Public or Private D r f,i'"� -
•Number of Stories l/
Wood Frame •Total square feet of floor area, -'4t~
❑Individual (septic tank,etc.) all floors,based on exterior '❑Structural steel dimensions f
❑Reinforced concrete TYPE OF WATER SUPPLY F
•Total land area,sq.ft.
❑Other-Specify OFF-STREET
❑Public or private company
NUMBER OF OFF-STREET `'"
❑Individual (well,cistern) PARKING SPACES
PRINCIPAL TYPE OF HEATING FUEL Enclosed yzyn
TYPE OF FIREPLACE t
❑Gas
❑Oil Outdoors
Electrici
RESIDENTIAL BUILDINGS ONLY ; ,,"
Number of bedrooms !
❑C•. TYPE OF MECHANICAL f
k
es Other-Specify Number of Full
bathrooms
Partial
IV. IDENTIFICATION- 'Y ;
•
NameMailing Address-Number,street,city
ty and State ZIP code Tel.No. :..,,,.
,. laphQ__ __-L0_4,_ q-3I7 A3 J L. �/�/ 'Owner � i 'eC" Y Q IV C 0�'�`e`" <�93,SC2 r _ `.
2.
''''.5f
Contracto State License No. I x
3 _
Architect i,_
F
The: er pf this building a - . e undersigned agree to conform to all applicable laws. i
fgnaWs�. applicant -— t Address
"/W $-.•
APPI.OGon date f
-
rPLANNING AREA FIRE DISTRICT SCHOOL DISTRICT
APP OVEO Y WATER DISTRICT____
JEFCOUNTY
HEALTH DEPARTMENT
APPROVED Y: PERMIT FEE -
ISSUE DATE RECEIPT NUMBER
Qt
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BUILDING OFFi I_ t1 Q i 0-0 �.-
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.e P,,nrr rr - Part TOKTISCnd
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APPROVED
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