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City of Fort C011inS 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
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Name I.}1 ->S
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Mail Address' r't� I ,� ✓�E f
Phone
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Name
Address y
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License No.
Phone
4
S.
Lot rBlock
Filing Number to
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Subdivision �rJ
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PUD �
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DESCRIPTION OF WORK
Stock Options
Plan No. Codes
' t,
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
'date
signed
— CLASS OF WORK —
New Alteration Addition Demolish Move
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Plbg. Mech. Elec. Struct. Fire Prot.
❑ ❑ ❑ ❑ ❑
Occ. Gr. Type Const. f')#)
Use Zone
Use of Building v ;
Floor Area
Het ht
No. Stories
Lot Area `--
Frontage JI
Occ. load
Occ. Change from
Plat File No. / i -
No. D.U.
Garage area it ,w
Fin. Bsmt. area
Type heat Hr , ' ",,po
No. Fireplaces or stoves
— RELEASES — Dates
Zoning
Engineering
Fire Department
Electric Department
Water R Sewer
Plan Review
Special Conditions:
Valuation FEES
Plan Checkpl
Permit
Parkland
City Sales Tax
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St. Oversizing
j -
Water Plant Investment
Sewer Plant Investment
i
Storm Drainage
1 1, A:'
_
Electric Underground
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Total Fees
Distrihuf & ?rlginaC+ Applicant; Blue - Office; Canary - Sales Tax; Pink - Applicant, Tag - Bldg. Insp.
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
Building Ins Approval / /
by
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tdate
it 0 -rot f
Permit No.
Date