HomeMy WebLinkAboutBLD1987-00454I __ __ _ , . .
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I. LOCATION: p-opraphic name S W SIDE OF ` _ROAD FEET
N E (90 l C/ ale I (SC,� ROAD
S W FROM INTERSECTION OF ROAD AND
other specibc location or landmark:
LEGAL DESCRI ION: c9-N --
Block Subd S
Lot ry 1.
67,l ig 7 Tax Number Y.Section Section Township Range
II.TYPE AND COST OF BUILDING•
TYPE OF IMPROVEMENT BUILDING TYPE J
IC WORKS APPROVAL
New building Single Family -
❑ dition Multi-Family -•_,. Access Permit No.
number of units
1 0 Alteration r''
0 Hotel,Motel,Dormitory Utili . Permit No. i
0 Repair,replacement number of units •
K. = Eme en Sery'-=-• No.
(�, 0Wrecking 0Mobile Home �
\ 0 Moving(relocation) 0 Other—Specify Street Wid = A:
``, ❑Foundation only
B:
‘.., tonal Permits red:
OWNERSHIP
Z''." 0 Private(individual,corporation,
nonprofit institution,etc.) �_� `��
❑Public (Federal,State or local goi/t.) UBC OCCUPANCY G8OUP:
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,enterrpcoposed use.
�`
b. Plumbing l, '.4 ` "— g AQ-3 ' yg 5 .41 / ^� (�
... Heating,air conditioning II ..1—i1�i(/� ♦ 1 ` If I �f . `� • .
d. Other(elevator,etc.) 64,0 • Z-//1 g 7 1
• TOTAL COST OF IMPROVEMENT -' 7I Ln 6 L_ ?(r/
III.SELECTED CHARACTERISTICS OF BUILDING F
DIMENSIONS ...
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DI SAL�� •ryumber of Stories.. .
❑Masonry (wall bearing) ❑Public or Private •Total square feet of floor area, F
0 Wood Forst F Qlndividuaf tseptic.tan ,etc.) all floors,based on exterior
J dimensions E.
Structural steel
0 Reinforced concrete
TYPE OF WATER SUPPLY •Total land area,sqmp .ft. (///
0 Public or private coany I `-r V)
0 Other—Specify NUMBER OF OFF-STREET❑Individual (well,cistern) PARKING SPACES
•
•
}`�� Enclosed i
\.r PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE •
Outdoors
0 Gas
Q Oil RESIDENTIAL BUILDINGS ONLY
1. le Number of bedrooms s
ERricity '�(�l c x cX / �
� TYPE OF MECHANICAL
❑Coal Nurrberof Full
0 Other—Specify bathrooms Partial tt
IV.IDENTIFICATION _ t•
Name Mailing Address—Number,street,city and tate ZIP code Tel.No.
� t. al- , - fiwfJ a0�1 OxO 0 l CL�; _ f� Yg3-
��� _ I.
->,,- °wrier Oo� 'a � 09' i
2. �� ,
State License No.
Contractor 1
3.
Architect I--
The owner of this building and the undersigned agree to conform to all applicable laws.
Appiiouon date j
ess
`/
of appi rat + Add,„,.....-7-...Z c..----3.-/ i _., ,-- •
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PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT ''
F.
5Prr
Eq q/ APPP.OV D3Y APPROVED BY f� vit. tya/r.� st,,d/ iy 5 6. �t40„3,..
JEFFERSOfi m DE
SHOVEL 1 NE DEPT.eFG'Sk ?ma
v fg _ PLANNING DEPT. �<
APPROVED Y: IPERMIT FEE ISSUE DATE RECEIPT NUMBER
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