HomeMy WebLinkAboutBLD1988-00357 BUILDING PERMIT APPLICATIO
Jefferson County Builc artment• County Courthouse •Port Tov Nash.98368 • 385-9141
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I. LOCATION: geographic name S W SIDE OF RO D FEET
NE
S W FROM INTERSECTION OF ROAD AND 11 1 I ROAD
other specific location or landmark: 0(.1 1110 I`Q. 0ll:A.)J. t ill '--1
pLEGALR! N: Lo Block Subdsion
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Q � 0 O 30 p X
Tax Number Y<Section Section ownship Range
II.TYPE AND COST OF BUILDING -
TYPE IMPROVEMENT BUILDING TYPE MOBILITY
w 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
❑Repair,replacement ❑Hotel,Motel, Dormitory at either the U.S.Navy's Trident or
number of units Indian Island Facilities?
❑Wrecking ! obile Home
❑Moving (relocation) • her—Specify ❑YES ONO
❑Foundation only
USE
OWNERSHIP
❑SecondRecreation Cabin,etc.
4 ❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: El Second Home: Future conversion to
J permanent residence
SO 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.
'N° a. Electrical If use of existing building is being changed,enter proposed use.
b. Plumbing (o`C C -
c. Heating,air conditioning n (/(0 0 ?I d. Other (elevator,etc.) ( & ,, itr'�A -
iY`
• TOTAL COST OF IMPROVEMENT $ ` ,, it
III.SELECTED CHARACTERISTICS OF BUILDING -
,/\ PRINCIPAL TYPE OF FRAME TYPE OF SEWA 1 SAL DIMENSIONS Q
❑Masonry (wall bearing) •Number of Stories l
❑Public or Private
•Total square feet of floor area,
❑Wood •Framendividua septic tan ,et ) all floors,based on exterior
❑Structural steel dimensions
TYPE OF WATER SUPPLY
❑Reinforced concrete •Total land area,sq.ft.
CPublic or private company
jOther—Specify` NUMBER OF OFF-STREET
��,rya a Individual (well,cistern) PARKING SPACES
�/ ) Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
El Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY
Electricity Number of bedrooms
❑Coal TYPE OF MECHANICAL
ElOther—Specify
Number of Full
bathrooms
Partial
IV. IDENTIFICATION - •
//y� Name Mailing Address—Number,street,city and State ZIP code Tel.No.
Owner Q.C1J .I 1. ,Cai(J1/V\\ + P, O ! (3 `/ �L . gg6l0 so
J , er3 Cc..1. 1 Sc \I cat 1/9- - y.27
2. S' 3
Contractor State License No.
- CA— 42 7(
3. 15 /4)Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Signature of applicant ( -D A dress Application date
`) .t.bate-- (�ri/ `-- Q,/it )(03 8 8 8
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY `
il ,in ,,,
. 30
JEFFERSO COUNTY HEALTH DEP_AR MENT
APPRC4Eiti ; '1 � PERMIT IS UE DATE RECEIPT NUMBER
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BUILDING OFFICIALJEFFE
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AKERSON COUNTY
MANNING&BUM OffT
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