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City Of Fort C011111S 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 i/ff�
Mail Address
pp
Phone
Name
Address
o
License No. �� �� it
Phone �f r ,• y
a
Lot
Block
Filing Number
y
Subdivision
0
PUD
_
6/
DESCRIPTION OF WORK
Le 7
f f Jv
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 above is correct and agree to comply with all city
ordinances and state laws regulating building construction.
signed date
— CLASS OF WORK —
New Altera ion Addition Demolish Move
❑ 9 ❑ ❑ ❑
Plbg. Mech. El Struct. Fire Prot.
❑ ❑ ❑ ❑
Occ. Gr.
Type Const.
Use Zone
Use of Building
Floor Area
Height
No. Stories
Lot Area -1-l"
F ontage
Occ. load
Occ. Ch pge fromfi"t
Plat File No.,
No. D.0
Garage area, /-� �11-1
Fin. Bsmt. area
r
Type-h at
No. Fireplaces or stoves
— RELEASES — Dates
Zoning
Engineering
Fire Department
Electric Department
Water & Sewer
Plan Review
Special Conditions:
Valuation FEES
Plan Check --
Permit
%
Parkland
City Sales Tax,._y.;j`
St. Oversizing
Water Plant Investment
Sewer Plant Investment
Storm Drainage
_
Electric Underground
Total Fees
Distribution: Ori anal - A licant;_Bl ue -•Office Ganar .- Sales Tax; Pink.: A `I icarit: Tam �
9 PP � �`v �Y' ,.. ..-,..PP 9-.Bldg.ln`sP. ♦__♦-
Yr _
Off -Street Parking
(No. Cars)
Interior Lot ❑
Corner Lot ❑
Reversed Corner Lot ❑
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Street
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ZBA Case # Date
BBA Case # Date
a
Building Insp. % Approval
by L, date
Permit No.
Date