HomeMy WebLinkAboutBLD1987-00443 r. E
I. LOCATION: prop sphic name S►V SIDE'OF, R AD FEET
lit
S W FROM INTERSECTION OF ROAD AND 6..
' c)c� Q ROAD
other specific location or landmark: � l 1
LEGAD fCpLN:
� �`�� t Block . . V Su ivision
o� 1 � )
9 'O 107 Taz Number Y.Section Section Township Range
II.TYPE AND COST OF BUILDING
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY •
❑New building Single Family ❑New County Resident
Addition ❑Multi-Family Is this structure to serve the residential
number of units or commercial needs of those employed
❑A teration
❑Hotel,Motel, Dormitory at either the US.Navy's Trident or
❑Repair,replacement number of units Indian Island Facilities? -
❑Wrecking ❑Mobile Home
❑Moving(relocation) 0 Other—Specify ❑YES ONO
❑Foundation only
USE
OWNERSHIP 0 Full-time Residence
❑Private(individual,corporation, ❑Second Home:Recreation Cabin,etc.
nonprofit institution,etc.)
❑Public(Federal,State or local gov't.) UBC OCCUPANCY GBOUP:.12-3 ❑Second Home:Future conversion to
permanent residence
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 proposed use.
b. Plumbing 3//tViAttr t,. ,(1 = �'
o035 �
c. Heating,air conditioning ( _
d. Other(elevator,etc.) f"
• TOTAL COST OF IMPROVEMENT $ s
wIII.SELECTED CHARACTERISTICS OF BUILDING -
a-c—' I NSIONS
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DIS
umber of Stories
Masonry(wall bearing) or Private r . ❑ g •Total square feet of floor area,
Wood Frame Individual (septic tank,etc.) all floors,based on exterior
dimensions t
tructural steel
TYPE OF WATER SUPPLY Total land area,sq.ft. t
0 Reinforced concrete
0 Public or private company -
❑Other—Specify NUMBER OF OFF-STREET i
0 Individual (well,cistern) PARKING SPACES I
r
Enclosed t
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE `-
❑Gas Outdoors
L:
❑Oil RESIDENTIAL BUILDINGS ONLY c:r ' xti
Number of bedrooms
❑Electricity
TYPE OF MECHANICAL
�j
❑Coal - Number of Full .-2 e C KI.
❑Other—Specify bathrooms �'
Partial
IV. IDENTIFICATION- -
Name Mailing Address—Number,street,city and S se ZIP code Tel.No.
P' ' 9c-7- ? ---,‘ "7/ !.
Owner
Contractor State License No. \ 1
3 r
.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.]Add / ' APVbtion dstt
S+gnat !applhorht / II---
-v-71_.c h---,
PLANNING AREA C FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT -
APPROVED BYJ� j 1 '� �/ "` ,
JEFFERSOf'i LIIAM!. • TH DEPARTMENT 0 V-"' •
APPROVED BY: - R EE ISSUE DATE RECEIPT NUMBER f'`
MI
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