HomeMy WebLinkAboutBLD1987-00462 _ _ 1
N EIIIII
I. LOCATION: propraphicname S W SLOE OF ' ROAD FEET
NE Old 6 .l0
S W FROM INTERSECTION OF ROAD AND,.��.-y+'v
1
othersperiffc location or landmark: P S
LEGAL D SCRIPTION: '` ubdwision
P �Lot
I
q 50980 Ci Section Township Range
)C X
Tax Number Y.Section
II.TYPE AND COST OF BUILDING .
TYPE OF IMPROVEMENT BUILDING TYPE PUBLIC WORKS APPROVAL
❑New building ❑Single Family
❑Addition ❑Multi-Family Road Access Permit No.
number of units
❑Alteration 0 Hotel,Motel, Dormitory Utility Permit No.
❑Repair,replacement number of units •
❑Wrecking 0 Mobile Home Emergency Services No.
❑Moving(relocation) ('Other—Specify Street Width A•
❑Foundation only t,uo i , .-n ry
. Additional Permits Required:
OWNERSHIP
0 Private(individual,corporation,
nonprofit institution,etc.) �_3
❑Public(Federal,State or local gov't.) UBC OCCUPANCY G5C+UP:
COST (Omit cenaJ 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 use of existing building is being changed,enter proposed use.`
b. Plumbing / 7 7 ir '� t
- c. Heating,air conditioning
d. Other(elevator,etc.) •
"'Y`-• • TOTAL COST OF IMPROVEMENT S
III.SELECTED CHARACTERISTICS OF BUILDING -
TYPE OF SEWAGE DISPOSAL
DIMENSIONS �'
PRINCIPAL TYPE OF FRAME ,'' •N4t*,4er of Stories
❑Masonry (wall bearing)/� (]Public or Private l'`•Total square feet of floor area, ///
Wood Frame ❑Individual (septic tank,etc.)7- all floors,based on exterior �'
0 /� �.,�` dimensions
Ma 4 0 Structural steel
Ox .- TYPE OF WATER SUPPLYr-1 •Total land area.sq•ft.
Qr.. 0 ReinforC d concrete
v ❑Public or private cgfinpany
❑Other—Specify NUMBER OF OFF-STREET
❑Individual (well;'cistern) PARKING SPACES .
,-• • �• Enclosed •
2,-- PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIR LACE Outdoors
,--
0 Oil RESIDENTIAL BUILDINGS ONLY
•
0 Electri ' rn Nub�of bedroomsTYP 'OF MECHANICAL /
❑ 1 Fun :
,N`urnber of,Other—Specifyir
�/bathrooms I
Partial
IV. IDENTIFICATION -
Name
Mailing Address—Number, reet,city and S , a ZlP code Tel.No.
(01O Old C_ �;1 = /
Owner
2. State License No. I
Contractor
Architect
e owner of this building and the undersigned agree to conform to all applicable laws.
,' Appellation date
.i,'. of appl /t Adorns n /15,
� 7~1 7
4.
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p • NING AREA
FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
'PROVED BY APPROVED 3Y APPROVED BY
- ► t 1,,,, IEAL-n4 DEF1 SHO
�?ELINE CEPT. PLANNING DEFT.
Amor
JEF-a-�•? � f ISSUE DATE RECEIPT NUMBER
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APP-• , s PERMIT FEE
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