HomeMy WebLinkAboutBLD1987-00461 4IkOF R AD FEET
I. LOCATION: proplsph;cname S W SIDE1 �� Yt(01_
ROAD
N E
S W FROM INTERSECTION OF ROAD AND
other specifc location or landmark:
(- /(
LEGAL SCRIPTION: � G AD I1),-.S CO (/ )� A
V # Llat Block
Subd�sio
Ck)
Tax Number Y.Section
�ction Township �Flar#pe
II.TYPE AND COST OF BUILDING-
TYPE OF IMPROVEMENT BUILDING TYPE
PUBLIC WORKS APPROVAL
*New building 0 Single Family
�❑Addition 0 Multi-FamilyFj Access Permit No.
number of units
Alteration ❑Hotel,Motel, Dormitory Utility Permit No.
Repair,replacement number of units
•
❑Wrecking 0 Mobile Home Emergency Services No.
0 Moving(relocation) ', lc Other-Specify Street Width A.
❑Foundation only D n�p.k0.) B:
. Additional Permits Required:
OWNERSHIP
❑Private(individual,corporation,
nonprofit institution,etc.)
❑Public (Federal,State or local gov't.) 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
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 us//e��off existing building is being changed,enter proposed use.—
b. Plumbing e2 ) ll O &OnVP 9_____9/ 10?)
c. Heating,air conditioning
d. Other(elevator,etc) --
• TOTAL COST OF IMPROVEMENT S
III.SELECTED CHARACTERISTICS OF BUILDING -
\� d �WMENSIONS
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISCOSS •Number of Stories I
❑Masonry (wall bearing) 0 Public or Private V/ C\C •Total square feet of floor area,
❑Wood Frame
//////������ Individua (septic tan ,etc.) all floors,based on exterior
dimensions
•
tructural steel /(� "*
TYPE OF WATER SUPPLY •Total land area,sq.ft.ReinforteC concrete ❑Public or private company
❑Other-Specify • NUMBER OF OFF-STREET
Individual (well,astern) PARKING SPACES •
• Enclosed
r PRINCIPAL TYPE OF HEATIN FUEL TYPE OF FIREPLACE Outdoors
❑Gas
❑Oil RESIDENTIAL BUILDINGS ONLY •
Number of bedrooms •
❑Electri • TYPE OF MECHANICAL
❑ Number of Full
Other-Specify bathrooms Partial iv
.E IV. IDENTIFICATION --
c: � ZIP code Tel.No.
.. [Jame Mailing Address-Number,street,city andd.Sta
--�- t. /DAco c,�,� -- <aa Co i o id 6(1 F, 77--
or " �Crii •vy, l rt.
��(`� �� -" State License No. I
` Contractor �U T5 1 13 S C-7 7/)/ 1
4, T t t f
- 3_ Yo l i_ai e-!. Jorcl 4+R�
Architect ,
The owner of this building and the undersigned agree to conform to all applicable laws.
Add� awn dame
Signet o� H P-Oni-e., 7—c -S---V
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT r
APPROVED BY APPROVED 9Y APPROVED BY
EF d1. -cou� e1 DE SHORELINE DEPT . PLANNING DEPT. i1.:-:
APPRO D B ' PERMIT FEE ISSUE DATE RECEIPT FIBER
r tea;cD W 5,__K7 6?
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