HomeMy WebLinkAboutBLD1987-00444 •
I. LOCATION: yeographicrtsme N E S W SIDE OF r ROAD FEET
S W FROM INTERSECTION OF ROAD ANDl."di) --- 7) ROAD
ie.)
other specific location or landmark:
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ILEGAL DESCRIPTION:
Lot Block , j)gSubdivision
'i (c l MO O L7 Tax Number Y.Section Section Township Range
I).TYPE AND COST OF BUILDING-
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY •
❑ ew building 0 Single Family 0 New County Resident
TCI Addition ❑Multi-Family Is this structure to serve the residential I
—\—\ number of units 0 Alteration or commercial needs of those employed
i'
0 Hotel,Motel,Dormitory at either the US.Navy's Trident or
❑Repair,replacement number of units Indian Island Facilities? •
4
❑Wrecking 0 Mobile Home I
❑Moving(relocation) /j'(?ther—Specify ❑YES ONO
❑Foundation only4
`?I }
mil , '-� v
••,, C'� USE
_
OWNERSHIPA��
.v ❑Full-time Residence
❑Private(individual,corporation, ❑Second Home:Recreation Cabin,etc.
nonprofit institution,etc.) ..,
❑Public(Federal,State or local goJt.) UBC OCCUPANCY GB OUP: - ❑Second Home:Future conversion to
permanent residence
(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,
Plumbing CJ I\ ae `/V V V� �,� ^/t/ (p
e. Heating,air conditioning 7 y / ( / J ` F
d. Other(elevator,etc) X c20 _
• TOTAL COST OF IMPROVEMENT $ CrSe)77e,i'1- s 20 0- 62
III.SELECTED CHARACTERISTICS OF BUILDING - i 'qq, r J ,
1v10' MENSIONS "p '
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPO�_�n�l)m *Number of Stories '' `'
❑ ❑Masonry(wall bearing) Public or Private�i (Y- f,
L �C l�1 •Total square feet of floor area, (,-.71.Frame XIndi�idua (septic tan etc.) all floors,based on exterior `,
/��\ dimensions �_+?
❑ ructural steel ,;. -
TYPE OF R SUPPLY •Total land area,sq.ft. ,:'g
0 Reinforced concrete
Pub lc or pr to company
❑Other—Specify \ NUMBER OF OFF-STREET --x
0 Individual ( 1,cistern) PARKING SPACES
Enclosed i''"s
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE I.
❑Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY r`Ey
'� C =I'r
Number of bedrooms L''�
❑Electricity
TYPE OF MECHANICAL
❑Coal • Number of FuII (,%'
❑Other—Specfy bathrooms k -'
• Partial
IV. IDENTIFICATION- .
Name Mailing Address—Number,wee,.city and State ZIP code Tel.No.
Owner — , 17
.
2. t
Contracto State License No.
..
a .
Architect , _
The owner of this building and the unders- ned agree to conform to all applicable laws. G
Sign of applio t / Addatirs Application date
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PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT •
APPROVED BY
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JEFFERSON COUNTY HEALTH DEPARTMENT'
APPROVED BY: I PERMITFEE ISSUE DATE RECEIPT NUMBER
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BUILDING OFFICIAL / S_` `IT— (9 (037 7
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