HomeMy WebLinkAbout6570 Portner Rd - Permits - 05/03/1983-City of Fart CC alli 10 aiii DING— !!KitS?€CTFOK1 nIVISir1N-
APPLICATION FOR BUILDING PERMIT 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
3
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Phone Q
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Name 5 /
mAddress
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0
U
License No.
Phone
Lot
Block
Filing Number
Q
Subdivision
PUD
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DESCRIPTION OF WORK
OUQ
Stock Options
Plan No. Codes
fist. Total Cost c
(including labor, material, profit)
I hereby acknowledge that I have read this application and
state that the above is correct and agree to comply with all city
ordinances and state laws regulating building construction.
.signed date
— CLASS OF WORK
New Alteration Addition Demolish Move
ZI ❑ ❑ ❑ ❑
Plbg- Mech. Elec. Struct. Fire Prot.
EI ❑ ❑ ❑ IT
Occ. Gr.
Type Const. li(-/% Use Zone
Use of Building Y
Floor Area
Height
No. Stories
Lot Area
Frontage
Occ. load
Occ. Change from
Plat File No. .,
No. D.U.
Garage area
Fin. Bsmt. area
Type heat _„a
No. Fireplaces or stoves
— RELEASES — Dates
Zoning
Engineering
Fire Department
Electric Department
Water & Sewer
Plan Review t
Special Conditions:
e.
/ `F J
p
Valuation
FEES
Permit
Plan Check
St. Oversizing
Water Plant Investment
Sewer Plant Investment
Storm Drainage
Electric Underground
City Sales Tax
Total Fees
Dlstributnn'-Clriginal - t�oplicant, Blue - Office', Canary - Sales Tax; Pink - Applicant Tag - Bldg. Insp.
Permit No.
Date
w
O
ZBA Case #
Date
BBA Case #
Date
Building Insp. --
Approval
date
Off -Street Parking
(No. Cars)
Interior Lot ❑
Corner Lot 9
Reversed Corner Lot ❑
a
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m
c
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Street