HomeMy WebLinkAboutBLD1988-00388 BUILDING PERMIT APPLICATION
Jefferson County Building•rtment• County Courthouse • Port Townsel lash.98368 • 385-9141
•
N E
I. LOCATION: geographic name S W SIDE OF J C� ROAD �� FEET
_
S W FROM INTERSECTION OF ROAD AND / I / 1 61 -_7J7ri ROAD
other specific location or landmark:
AEG/AL DESCRIPTION: s)
* Lot Block L^ Subdiv,sigta
oal (. l)a�V Ta umber IA Section Section Tofwwn1/shhiip Range
II. TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
d New building Single Family ❑New County Resident
r
PA 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 ❑Mobile Home
❑Moving (relocation) ❑Oth r— pecify f .04 ❑YES ❑NO
❑Foundation only r c
Q USE
OWNERSHIP
❑Full-time Residence
i ❑Private (individual,corporation,
nonprofit institution,etc.) ❑Second Home: Recreation Cabin,etc.
r ❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: ❑Second Home: Future conversion to
% permanent residence
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,ente proposed use.
b. Plumbing lE` J ya"C c& — i],
c. Heating,air conditioning
d. Other (elevator,etc.) -
• TOTAL COST OF IMPROVEMENT $
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
❑Masonry (wall bearing) •Number of Stories
Public •or Private !Total square feet of floor area,
❑Wood Frame ❑Individual (septic
tic tank,etc.) all floors,based on exterior �/
❑Structural steel r dimensions ///
TYPE OF WATER SUPPLY Total land area,sq.ft. r1
❑Reinforced concrete • 63
❑Public or private co any t 73.
❑Other—Specify NUMBER OF OFF-STREET
❑Individual (well istern) PARKING SPACES
Enclosed
PRINCIPAL T E OF HEATING FUEL TYPE OF F2L4LACE
El Gas Outdoors
❑,pil // RESIDENTIAL BUILDINGS ONLY
Electricity „Number of bedrooms
❑Coal PE OF MECHANICAL
❑Other—Specify Number of Full
bathrooms
' {Partial
IV. IDENTIFICATION -
Name Mailing Address—Number,street,city and State ZIP code Tel.No.
1. fiJ)C C>Rk3 ? 's- 76703
Owner 1�
v �
2.
Contractor State License No.
3.
Architect ,,
'he o r of this b I ing and he undersigned agree to conform to all applicable laws.
Add�- i i _
Applicat' n date
of " ican /
4f ai 7� CD/PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY
JEFFERSON COUNTY HEALTH DEPARTMENT
APPROVED BY: PEEWIT FEE ISSUE DATE RECEIPT NUMBER
f< VC)
3,5—CD
BUILDING OFFICIAL474'7A) 3c./623 ()
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