HomeMy WebLinkAboutBLD1987-004261
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Jefferson County Building .r-trnent • County Courouse • Port Towns Vash.9836E • 385-1310
I. LOCATION: geographic name Inc. S W SIDE OF* ,"i 0r''1 i'Qa/9' yy� ROAD_ 1 C�3' , FEET
S�l FROM INTERSECTION OF G� ROAD AND IC�1 I f tU t-w— ROAD
1
other specific location or landmark:
1 tS LEGAL DESCRIPTION: k)
ir �o _ _ Q 4 a / Lot . Block Subdivision
<) Tax Number %Section Section Township Range
N-1 II.TYPE AND COST OF BUILDING -
y�
``'a TYPE OF IMPROVEMENT BUILDING TYPE
a"-- MOBILITY
,, New building ❑Single Family INYNew County Resident
X"\\j ❑Addition ❑Multi-Family Is this structure to serve the residential
`. ❑Alteration
number of units or commercial needs of those employed
❑Hotel,Motel, Dormitory at either the U.S.Navy's Trident or
i ❑Repair,replacement number of units
❑Wrecking Indian Island Facilities?
, Mobile Home
❑Moving (relocation) ✓✓ ��
❑Other-Specify ❑YES NNO
❑Foundation only Q /
USE
OWNERSHIP
y�, FFull-time Residence
�J Private (individual,corporation,
nonprofit institution,etc.) 22 ❑Second Home: Recreation Cabin,etc.
Li Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP:X-✓ M-1 ❑Second Home: Future conversion to
permanent residence
COST (Omit cents)
Nonresidential- Lcribe 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 propo use.
b. Plumbing ` ,e/ ' I w
r(l cr, afp r I L
k.ae.:),
c. Heating,air conditioning / GQ`�� w��
d. Other (elevator,etc.) eo � i 'C 19 8-7
• TOTAL COST OF IMPROVEMENT $ ,I eCWI Z4,c 4 e' ' • 1 15,2 e- ; Gy l 2 tf L
t 1 V f
III.SELECTED CHARACTERISTICS OF BUILDING -
Ji I
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DIS tc(04/O±MENSlONS
❑Masonry (wall bearing) ❑Public or Private •Number of Stories
14------ ••Total square feet of floor area,
�j ❑Wood Frame ,..... 1 ndividu septic tank,etc.) all floors,based on exterior
ot ❑Structural steel ._ / dimensions +16.8
TYPE OF WATER SUPPLY
�❑/Reinforced concrete •Total land area,sq.ft.
!Xl Other-Specify IDPublic or private company Ig®i 99-c
L�� NUMBER OF OFF-STREET
pCI fndividu(iwell, intern) PARKING SPACES
PRINCIPAL TYPE OF HEATING FUEL Enclosed 2.
TYPE OF FIREPLACE
—.._J ❑Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY
Electricity Number of bedrooms C
oal TYPE MECHANICAL
Number of Full
Other-S cif C
bathrooms
OlF Te_ Partial
IV. IDENTIFICATION - - •
Name Mailing Address- Number,street,city and State ZIP code , Tel.No.
,. F(b[[-Ql� '�0 % <b/C� y IV/� 9 ',5BS-)G44
Owner L.�'(' k) l'e /V(�k d Caw..ci
2. �a1_b - 4S+ Eel 2aA-�`�L-
Contractor State License No.
Lss v EG k.+i i.1 !-4'—Ve-9rt 2--Wo? tNJ o Q4)L.i-)-1_, ggas' $-I‘4¢-
3.
Architect .
The owner of this building and the undersigned agree to conform to all applicable laws.
Sig ture of a licant Addre s Q pplication date
PLANNING AREA N FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY 14 M 0 VA( '3. /a
(--it(--)
JEFFERSON COUNTY HEALTH DEPARTMENT -
'PROVED./AY:i PERMIT FEE ISSUE DATE RECEIPT NUMBER
100 . a
(')(^-A, - 1 t - 00
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