HomeMy WebLinkAboutBLD1987-00450 -- -- --- ilk I. L
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R 5C Q.l [►O ElN: proprephic name
5 W SIDE OF _ROAD FE
JEFF.RSON COUNTY N E ROAD AND G>ccC�r/iL3vsf/ /QEC' ,Po.�t� ROAD
S W FROM INTERSECTION OF
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Q -1' Al C F 7- � //tic/-TLE/3en.2 y
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otharspa:i/ic location or landmark:_ 7 / ^-�- �J1
PLANNING EiPGA4T Ota1. CRIPTION: 5r"� /,�'/f 0 l si
Lot
Block Subdivision
z
Tax Number Y.Section Section Township / Range
II.TYPE AND COST OF BUILDING-
TYPE OF IMPROVEMENT BUILDING TYPE
PUBLIC WORKS APPROVAL
New building Single Family
❑Addition 0 Multi-Family number of units Road Access Permit No.
Alteration ❑Hotel,Motel, Dormitory Utility Permit No.
❑Repair,replacement number of units •
❑Wrecking 0 Mobile Home Emergency Servic=- No.
❑Moving(relocation) ❑Other—Specify Street Width A:
0 Foundation only
B:
(• , . Additi••-1 Permits Required:
c", s OWNERSHIP
0 Private(individual,corporation, ,
nonprofit institution,etc.)
J 0 Public (Federal,State or local govt_) UBC OCCUPANCY GROUP:
(^ COST (Omit cents) Nonresidential— Describe in detail proposed use of buildings,e.g.,food
• Cost of improvement
S processing plant,machine shop,laundry building at hospital,elementary
t ) To be installed but not included school,secondary school,college,parochial school,parking garage for
department store,rental office building,office building at industrial plant.
in the above cost
If use of existing building is being changed,enter proposed use.
a. Electrical b. Plumbing ( �/0 /� a LI ----a //Apt'
e 3s,
G Heating,air conditioning /
d. Other(elevator,etc.)
• TOTAL COST OF IMPROVEMENT S I
III.SELECTED CHARACTERISTICS OF BUILDING - DIMENSIONS
IPRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL
•Number of Stories
0 Masonry(wall bearing) 0 Public or Private •Total square feet of floor area,
IWood Frame 0 Individual (septic tank,etc.) all floors,based on exterior j�D S/r.
dimensions, `) ,
[]Structural steel '"
TYPE OF WATER SUPPLY •Total land area,eq.f. L��-s
0 Reinforced concrete 0 Public or private company
Other—Specify NUMBER OF OFF-STREET
❑ individual (well,cistern) PARKING SPACES
1` Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE Outdoors
❑Gas
,.-
0 Oil RESIDENTIAL BUILDINGS ONLY
Number of bedrooms
( Electridty TYPE O ECHANICAL
❑Coal Number of Full f
y ❑Other—Specify /` bathrooms partial j
Y
IV. IDENTIFICATION - `'
Name Mailing Address—Number,street,city and State ZIP code Tel.No.
Ovine. V 195/70/1%, /O,4fi: , o 70 t'
I � 0- ,0)C 700 S/r V f0.� G�/n1 9�5 rri y-1l.26/,`' I.
U/</I✓3j `1�� /l�s (State License No. t
rector
-�i' f"
Architect i I
The owner of this building and the undersigned agree to conform to all applicable lawns. 1
Signs Idito .loot
Address . Application dam
x f- o-f5'ox 706 5 E/i /// - Fs-- -�<fx 7/7/77 .
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPRPV D BY APPROVED 3Y APPROVED BY • 1
0V id 1-i5- 7 ,•
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JEF 4 COUNTY
TH D£
SHORE:L I NE CEPT . PLANNING DEPT. t'
APPROVED B - PERMIT FEE ISSUE DATE RECEIPT NUMBER
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BUILDING OFFICIAL se) 6
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