HomeMy WebLinkAbout824 Kimball Rd - Permits/Single Family New - 05/05/1983or-'P'Ort Uolllns 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 (X�, 0 AT k 1 / / f
Name x/,r', �t Fr _ ;�/. r•
Mail Address
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` Phone
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0
Name ..•� . l . ; f f' ::
Address
E
License No. %? _ ;/
Phone 4 fl� fF
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a
Lot � r
Block
Filing Number
Z3
Subdivision
PUD
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v
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DESCRIPTION OF WORK
I r
Stock Options
Plan No. Codes
Est. Total Cost •'4' q- crr o - r
(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
O' ❑ ❑ ❑ ❑
Plbg. Mech. Elec. Struct. Fire Prot.
❑ ❑ ❑ ❑ ❑
Occ. Gr. Type Const.
Use Zone RL
Use of Building tt .� t E f f', t:l i f `/
Floor Area �(':/(t 7J
Height
No. Stories/
Lot Area 9011
Frontage y �j
Occ. load 10�
Occ. Change from
Plat File No. 3 ycf
No. D.U.I` CA,` ,- %Qrc)L-
Garage area /1$Q J -
Fin. Bsmt. areer,
Type heat '-
No. Fireplaces or stoves —
f`fEEASES — Dates
Zoning 00 J/?A
Engineering
Fire Department
Electric Department
Water & Sewer
Plan Review
Special Conditions:
.r
Valuation j' TCC' FEES
Plan Chec 7 i %n'
1 1 Z),�,
Permit v
1 .$^
Parkland
City Sates Tax-
✓ f/!7 '611
St. Oversizing
Water Plant Investment
/.50 •
Sewer Plant Investment
/+r/�D.,
1 -50 '�!V
Storm Drainage
o;3•a.$^
Electric Underground
Total Fees
o O
Off -Street Parking
.a
(No. Cars)
Interior Lot
10
Corner Lot
❑
Reversed Corner Lot
❑
m
S >
M
m
cc
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nil
t� I
at
at
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C6 0
N
Street
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ZBA Case#
Date
BBACase#
Date
Building Insp. Approval
by
date
1
042a
VAY051983
Permit No.
Date - A-r _ '
Distribution 011Jnal= A lcant,Blue - Office:Canary - Sales Tax:Pink - Applicant: Tag - Bldg. Insp