HomeMy WebLinkAbout1117 Centennial Rd - Permits/Reroof - 05/01/1987of,.,Fori C o
'llihS,- BUILDING INSPECTION DIVISION
APPLICATION- FOR BUILDING PERMIIT AND CERTIFICATE OF OCCUPANCY
- Applicant complete this part of form only.
Press firmly using ball point pen,
Job Address
Name �
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Mail Address 7
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Phone'r
Name /
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Address -
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License No.
6"
Phone
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Lot
Blodk lFiling
Number
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Subdivision
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PUD
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Parcel #
DESCRIPTION OF WORK
Stock - Options
Plan No. Codes
Est. Total Cost
(including labor, material, profit) '
I hereby acknowledge that I have read this application and
_state that the ab ve is correct and agree to comply with all city
ordinances an state laws regyfalmigbuilding construction.
c
signed date
—'CLASS OF WORK —
New Alteratio Addition - Demolish - Move
❑ ❑ ❑ ❑
Plbg. Mach. Elec. Struct. Fire Prot.
❑ ❑ ❑ ❑
Occ. Gr. - Type Const
Use o
Use of Building -
F)oorArea
e h
No. Storie
L ea
Fron
Occ. to
O hange from
Plat Fil o.
o. U.
Garage area
n. mt. area
Type heat No. Fireplaces or stoves
- RELEASES — Dates
Zoning
Engineering -
Fire Department -
Electric Department
.Water & Sewer
Plan Review
Special Conditions:
pU
Valuation FEES
Plan Check
-
Permit
4
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
❑
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Street
PRiMTS
50.50
TOTL
50.50
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CHCK 50
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N99609.09.11 A
M
MAY.01'87.,
ZBA Case #
Date
BBACase# -
Date
Building
Insp.
Approval
by
_
date
Permit No.
Date -
K.
1
Distribution: Original _Applicant: Blue - Office, Canary - Sales Tax: Pink - Applicant, Tag -Bldg Insp.