HomeMy WebLinkAboutBLD1988-00397 r, t
I. LOCATION: propraphic name S W SIDE OF ii ROAD FEET
S W FROM INTERSECTION OF ROAD AND,, .7 B
// / l G A Poe_(A)OAD
other specific location or landmark:
9LEGAL D CRIPTION: Block Subdivision
Lot ---7 i)A ) 1,
Tax Number Y.Section Section Township nge
Il.TYPE AND COST OF BUILDING -
TYYPE F IMPROVEMENT BUILDING TYPE PUBLIC WORKS APPROVAL
S yv
Nebuilding 0 Single Family
QAddition ❑Multi-Family Road Access permit No.
number of units
❑Alteration Q Hotel,Motel, Dormitory
Utility Permit No.
Q Repair,replacement number of units
Q Wrecking ❑Mobile Home EMergenCY Services No.
0 Moving(relocation) Other-Specify Street Width A:
� ❑Foundation only
( /
t J �`.1C f) B
Additional Permits Required:
OWNERSHIP
0 Private (individual,corporation,nonprofit institution,etc.) /
0 Public (Federal,State or local gov t.) UBC OCCUPANCY GROUP: /
^^ COST (Omit cents) Nonresidential- Describe in detail proposed use of buildings,e.g.,food
VCJ processing plant,machine shop,laundry building at hospital,elementary
• Cost of improvement $
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.
If use of existing building is being changed,enter proposed use.
a. PlumbingElectrisal / I a VD r / 91/ c.. .n.)
b. ,�x/'�'-ff C� �
C. Heating,air conditioning 50 h "� C) - t& 2 v
d. Other(elevator,etc.)
• TOTAL COST OF IMPROVEMENT S
III.SELECTED CHARACTERISTICS OF BUILDING
!
DIMENSIONS Q.,'
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL / •Number of Stories..
Q Masonryd (wall bearing) 0 Public or Private / •Total square feet of floor area,
� Sir Frame 0 Individual (septic ink,etc.) all floors,based on exterior -
dimensions
Q uctural steel
TYPE OF WATER SUPPLY •Total land area,sq.ft. �t
Q Reinforced concrete
9 lic or private company NUMBER OF OFF-STREET
❑Other-Specify ,.--'Q Individual (well,astern) PARKING SPACES
Enclosed • •
•
•
PRINCIPAL TYPE OF HEATING FUEL- TYPE OF FIREPLACE Outdoors '
Q Gas
Q Oil RESIDENTIAL BUILDINGS ONLY
Number of bedrooms
Q Electrici TYPE OF MECHANICAL
❑Co*' Number of FuIL I,
,I_J�Other-Specify bathrooms Partial e
IV.IDENTIFICATION - i,
Name Mailing Address-Number,street,city and State ZIP code Tel.No. )
i
^ er.
Q 'f
2. C' 4 State Lhcense No. ;
Contractor 1
f
O.- Architect i� .
The ownef'of this building d tote undersigned agree to conform to all applicable laws.
4....
gnatuteof avP! +nc /�` Y) •
Adc)ress /�//��` A/chi-Q._
—date7—/ 7___V i
_, L
FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT M
PLANNING AREA !
�AP-P VED BY APPROVED 3`; APPROVED BY
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�ON `-�`� J�"\ SHOPE'L I NE DEPT. PLANNING DEPT.
JEFFERSON '• HEALTH DEF'jE
APPR�/�� "/� ® a.o 7 I FEE
ap ISSUE DATE RECEIpi'NUMBER
•
MAR 8 88 3 ,S� 3/7/NA y
.,_
BLlILOIN9ERMEN COUNTY I
PLANNING&BLUb UN'I T/r P .ntr y — P.»r TO.tinsrnd _
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APPROVED
MAR 1�6 ecn �c4...,c T °IC—At.,
JEFFERSON COUNTY
PLANNING&RUG DEPPT �3rsf'
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