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HomeMy WebLinkAbout719 Breakwater Dr - Permits/Single Family New - 09/19/1985YCity Of Fort COl11nS 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 iT r,.X - Name `rf \.-.-C Mail Address Phone?i>,�) it Namet Address —, License No. Phone _° Lot,{ Block Filing Number''2, a) Subdivision PUD (,g� r DESCRIPTION OF WORK S @ is w a.� ;..�`%.m' r-•. l €"'.i.: '�"°�.!'"`�.�` Stock Options Plan No. Codes Est. Total Cost- lincluding labor, material"profii)` I hereby acknowledge that I have read this application and state that the above is correct'and agree to comply with all city ordinances`andd statlawsFregulating building construction. t. signed '- aM�, date...'�g: or — CLASS OF WORK — Newo, Alteration Addition Demolish Move O ❑ . ❑ ❑ ❑ Plbg. Mech. Elec. Struct. Fire Prot. ��• ❑� nor ❑ Occ. Gr. Type Con st. - Use Zone 12L Use of Building (�Iil Floor Area Height_);; No. Stories � Lot Area Frontages'; €_ a- 1- r-.1- -,� Occ. load ... Occ. Change from Plat File No. 3.60- r 3, No. D.U. J Garage area i^ Fin. Bsmt. area Type heat _f , a No. Fireplaces or stoves — RELEASES — Dates Zoning Q 1,, Engineering Fire Department Electric Department Water & Sewer Plan Review Special Conditions: ,�- '� (�• _ (/ // ))jam/�j//��{{J(j�y/ •� Valuation ?=FEES Plan Checks -PermitEr'Tq —ram Parkland T1? 2- y City Sales Tax V St. Oversizing Water Plant Investment Sewer Plant Investment Storm Drairiage Electric Underground Total Fees i z V•,; , Distribution: Original - Applicant: Blue -Office: Canary - Sales`Tax. Pin��Applicant* Tag Bldg `Insp.,, Off -Street Parking (No. Cars) Interior Lot ©, Corner Lot ❑ Reversed Corner Lot ❑ 1 m ! V v, (� - 1°v t• tp•_ to 0 Street `P ITS 800.5p;'- rtiKFF_-E r.: 'r A0 TAXPM225500 3) T OYi :_'tr` .00 'JGEI(C 318.00 0 TOTL 4247.51 co n CH&C"K �$21 • > N20816 08:05 A SEP-1 785 ZBA Case # Date BBA Case # Date Building Insp. •.`� Approval by fj : _ date rJ Permit No., Date { M