HomeMy WebLinkAboutBLD1987-00448 0
I. LOCATION: geoyraphicname S W SIDE OF ROAD FEET
S W FROM INTERSECTION OF ROAD AND J "` ) / 0 7ROAD
4 0 1 Tlif3 lt C4 Mokitt— NCf 1La�
other specific location or landmark:
LEGAL DESCRIPTION: *7
Lot Block Subdivision
� Pctoiot-[a CCU a� Ik.) .
Tax Number Y.Section Section Township Range
H.TYPE AND COST OF BUILDING-
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY •
r\ U r►uew building ❑Single Family
❑Multi-Family ❑New County Resident
dition Is this structure to serve the residential I
❑Alteration number of units or commercial needs of those employed
❑Hotel,Motel, Dormitory at either the US.Navy's Trident or
❑ replRepair,
acementnumber of units Indian Island Facilities?
❑Wrecking ,Mobile Home
❑Moving(relocation) 0 Other—Specify ❑YES ONO I!-
❑Foundation only
USE
OWNERSHIP 0 Full-time Residence
❑Private(individual corporation,
nonprofit institution,etc.) / ❑Second Home:Recreation Cabin,etc.
0 Public(Federal,State or local gov't.) UBC OCCUPANCY GROUP: 0 Second Home:Future conversion to
.. permanent residence
COS (Omit cents) Nonresidential— Describe in detail ro p posed 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 ilg7
l I'..
c. Heating,air conditioning
d. Other(elevator,etc.)
/(T''K So' �.
•
• TOTAL COST OF IMPROVEMENT $
III.SELECTED CHARACTERISTICS OF BUILDING - r•
•``
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS -+?
❑Masonry(wall bearing) ❑Public or Private •Number of Stories k
•Total square feet of floor area, E
❑Wood Frame 0 Individual (septic tank,etc.) all floors,based on exterior ":"
0 Structural steel dimensions
❑Reinforced concrete TYPE OF WATER SUPPLY •Total land area,sq.ft .,
❑Public or private company
Other—Spec,ify NUMBER OF OFF-STREET►rylr;. IUt 'G ❑Individual (well,cistern) PARKING SPACES
1 IrV T Enclosed ..
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE !
❑Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY r
❑Electricity Number of bedrooms
Coal • TYPE OF MECHANICAL
Number of Full ) -
❑Other—Specify bathrooms ''
. Partial ' �,
• IV.IDENTIFICATION-
Name Mailing Address—Number,street,city and State ZIP code I Tel.No.
1. ,/,Q)12t:_f_a\C-IS P 0 e)Cf3T75 ° igli .SLE . -I q Q e :'; -
Owner
k
▪ y Contractor State License No. _ 4
a
Architect r
1The owner of this building and the undersigned agree to conform to all applicable laws.
'
Address Appliration date
` lure of applicant
c� i-tb-- _ can c P- a 3-a7 .
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT [ .':
APPROVED BY `` It -
IG � sb.�� V�o4--e �Mt.A-k-1/4...
JEF COUNTY HEALTH DEPARTMENT -
APPROVE BY: PEEN FEE ISSUE DATE RECEIPT NUMBER
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BUILDING OFFICIAL / S
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The P,,nt•'r,• — Port Tc, ,scnd .......h,H (a
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APPROVE
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02J.29 /88 -
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