HomeMy WebLinkAboutBLD1987-00449 •INE it, .
I. LOCATION: geographic name S W SIDE OF ROAD FEET
NE f
S W FROM INTERSECJION OF ROA9 AND ROAD
other specific location or landmark: ( rn 1 ► `���\oAf; ,
LEGAL ESCRIPTION:
. Lot Block Subdivision] ) 60
Tax Number Y.Section Section ownship "Range
i `, II.TYPE AND COST OF BUILDING-
le TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY •
New building 0 Single Family 0 New County Resident
.
❑Addition 0 Multi-Family Is this structure to serve the residential
number of units❑Alteration or commercial needs of those employed
Hotel,Motel, Dormitory at either the US.Navy's Trident or
0 Repair,replacement ��/ number of units Indian Island Facilities?
0 Wrecking p9 Mobile Home
' ❑Moving(relocation) J07Other—Specify ❑YES ONO
4. 0 Foundation only
USE
OWNERSHIP 0 Full-time Residence
❑Private (individual,corporation,
nonprofit institution,etc.) n ❑Second Home:Recreation Cabin,etc.
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: (�3 0 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 [Cl f 5 , 5
c. Heating,air conditioning
d. Other(elevator,etc.)
• l
• TOTAL COST OF IMPROVEMENT $
�_ III.SELECTED CHARACTERISTICS OF BUILDING -
•
F,:
I
4.T' , DIMENSIONS �-
.,,�,✓ PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL
❑Masonry(wall bearing) *Number of Stories _a
❑Public or Private •Total square feet of floor area,
N ❑Wood Framendividua(t (septic tan'k1 etc.) all floors,based on exterior 44:'
❑Structural steel //�� \\ dimensions
❑ TYPE OF WATER SUPPLY •Total land area,sq.ft. I,
einforced concrete
❑Public or private company
Other—Specify NUMBER OF OFF-STREET
y�CI Ln
Q Q� D Individual (well,cistern) PARKING SPACES
Enclosed
PRINCIPAL TYPE O EATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
`
❑Oil RESIDENTIAL BUILDINGS ONLY
Electricity Number of bedrooms
TYPE OF MECHANICAL '
�l • Full 4
Number of )
❑Other—Specify bathrooms e
Partial
IV. IDENTIFICATION- -
Name Mailing Address—Number,street,city and State ZIP code Tel.No.
OwnerPT
_
.
Contractor * State License No-
3 .
Architect -
The owner of this building and the undersigned agree to conform to all applicable laws.
gnature applcant Address Application date
' Pa ���7 ,� :; 4 ,
PLANNING AR A FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED 4 -
JEF a- -• HEALTH DEPARTMENT
APPROV= ► B'• PERMIT FEE ISSUE DATE RECEIPT NUMBER E
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