HomeMy WebLinkAboutBLD1987-00456 hUELDING PLFi;,'�IT rd; I-:LlCf;-i i ON lis
Jefferson County Building De*neat • County Courthoaoge • Port Townsenc: sh.98368 • 385-1310
N E
I. LOCATION: geographic name S W SIDE OF _, ROAD FEET
NE / 0(c Ffq r rh /
S W FROM INTERSECTION OF ROAD AND �}2, � -� ' /t)
other specific location or landmark:
LEGA D CRIPTION: Pt�t
Pa d Lot Block S 1 Subdiv[�ion � � ��
goi J i t VO W i� Tax Number '%Section Section vnT`ow(�n/sshhiipp) Range
II.TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
)(New building ❑Single Family ❑New County Resident
❑Addition ❑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
❑Repair,replacement number of units ?
Indian Island Facilities.
❑Wrecking ❑Mobile Home
❑Moving(relocation) Other—Specify ❑YES ❑NO
❑Foundation only �\Ci7
(ir'rUSE
OWNERSHIP ❑Full-time Residence
❑Private (individual,corporation,
❑Second Home: Recreation Cabin,etc.
nonprofit institution,etc.) 1
❑Public (Federal,State or local goat.) UBC OCCUPANCY GROUP: 1
�/ /1 ❑Second Home: Future conversion to
permanent residence
COST (Omit cents) Nonresidential— Describe in detail proposed use of buildings,a.g.,food
Cee)....N&
• 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 3(' )4 g31//0 0€ g c/
c. Heating,air conditioning
d. Other (elevator,etc.)
) • TOTAL COST OF IMPROVEMENT $
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III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
•Number of Stories
0-ft, ❑Masonry (wall bearing) ❑Public or Private
•Total square feet of floor area,
Wood Frame ❑Individual (septi nk,etc.) all floors,based on exterior
dimensions
❑Structural steel
,.i'I TYPE OF W ER SUPPLY ft sq.
❑Reinforced concrete •Total land area, 11 A
lic or private company
..,,•.j ❑Other—Specify NUMBER OF OFF-STREET
Individual (well,cistern) PARKING SPACES
-Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY
❑Electricity Number of bedrooms
❑Coal TYPE OF ME ANICAL
Number of Full
ther—Specify bathrooms
Partial
IV. IDENTIFICATION-
Name Mailing Addhress—Number,street,city and State ZIP code Tel.No.
Owner 4 J eC )CQ.GC 14 _ i-/a/
2.
Contractor State License No.
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
i nature of applican Address Application date
, 3etin\cu
4,1„,e_
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPo��� _to-
JEF HEALDEPARTIrIENT •
APPR PERMIT FEE ISSUE DATE RECEIPT NUMBER
3/ --I o 7 'll5 913 '6
BUILDING OFFICIAL - I SO
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