HomeMy WebLinkAbout1109 Kirkwood Dr - Permits/Sprinkler - 07/28/1987City of Fort Co11inS BUILDING INSPECTION DIVISION
APPLICATION FOR BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY
Applicant complete this part of form only.
Press firmly using ball point pen.
Job Address
Name��
`v
c
Mail Addres�
3
O
Vbl
Phone
`o
Name
^
Address
`o
a
U
License No.
Phone
C
°
n
Lot Btock
Filin g Number
m
Subdivisio Y}(on / O '�
�
m
PUD �
Parcel #
DESCRIPTION Cl WORK
Stock Options
Plan No. Codes
Est. Total Cost
(including labor, material, profit)
I hereby acknowledge that I have read thisapplication and
state that the above is orrect and agree [o comply with all city
ordina es and sta a regulati building construcytion.
sig tlate
— CLASS OF WORK —
Ne Alteration
❑
Addition Demolish
❑ ❑
Move
❑
Pibg. Mach.
iY ❑
Ell Struct. Fire
❑ ❑
Prot,
❑
Occ. Gr, Type Const.
Use Zone
Use of Building
Floor AreaV
No. Stori
ontagOcc.
to
Plat FitGarage
areaeaType
heates
or stoves
—
RELEASES — Dates
Zoning
Engineering
Fire Department
Electric Department
Water & Sewer
Plan Review
Special Conditions:
Valuation
FEES
Plan Check
Permit
i
Parkland
City Sales Tax
',�"
St. Oversizing
Water Plant Investment
Sewer Plant Investment
Storm Drainage
Electric Underground
Total Fees
Off -Street Parking
(No. Cars)
Interior Lot ❑
Corner Lot ❑
Reversed Corner Lot ❑
m
m
!la
y
Y
c
O
Street
PRMTS 15.00
TQTL 15.00
CHCR 1
N92393 00=10 A
7UL.28'87
0
0
is
9
7
ZBA Case # Date
BOA Case # Date
Building
Insp.
Approval
by
date
,,-3O
Permit No.
Date
Distribution: Original - Applicant, Blue - Office; N.,
ary - Sales Tas Pink - Applicant. Tag - Bldg. lnsp.