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Clty of Fort Coj[ InS BUILDING INSPECTION DIVISION
APPLICATION FOR BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY
Applicant complete this part of form only..
Press firmly using ball point pen. _
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Job Address 41vo ftt :fV111A •t om f.,µ.
Name' •
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Mail Address�y:�a�,-
Phone
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Name
Jam' ,�`-.e�•F...IAA.� C...9Pe
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Address 'T.�'` 6, -ttlift
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License No.
Phone
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Lot
Block
Filing Number
N
Subdivision
J
Parcel # ?60 ._ 7 _ Oal
DESCRIPTION OF WORK
IW,I Cel
Stock Options
Plan No. Codes
cc ii
Est. Total Cost x :+ 1500 _,__Amt"`t -AW el
(including labor, material,iprofit)
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 ^Trdare
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— CLASS OF WORK -
New Alteration Addition Demolish Move
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bq. j(Me❑ch. Elec. Str❑uct./ Fire,Prot.
Occ. G\ Type Co [?' 0,-Use/Zone ;
s of Buildin y t
,Floor Area 1 -3. ht
4 p Hia $
No. Stories -z,o, Lot Area ' t.t- ,Frontage
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Occ. load Occ:��taa�g I"'���'� .�• �
1
Plat File Noy i :INo D. / )
Garage area Fin. Bs`r 1,,area
Type heat No. Fireplaces or stoves
— RELEASES — Dates
Zoning-,,.7
Engineering,
Fire Department>
Electric Department -
Water & Sewer
Plan Review L74
Svw
pecial Conditions: 1 4
� ` f
- - . F
Valuation I C/ -f' FEES
Plan .Check
i.:• '.
Permit
Parkland
City Sales Tax s
St. Oversizing
Water Plant Investment rZ
Sewer Plant Investment
Storm Drainage l %
Electric Underground
[Total Fees 1 f T) <- &
N
Off -Street Parking t�
(Nos)
InterioY'Lot -
Corner Lot ❑
Reversed Corner Lot ❑
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ZBA Case # Date
BBA Case # Date
Building Insp. e' Approval
by g" . date
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Lam.. 7
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Permit No. '-Date
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Distribution: Original - Applicant Bln - Offi ; Ca`na`ry-- Sales Tax: Pink - Applicants, Tag=•Bldg..lnsp. i.` � )
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Off -Street Parking t�
(Nos)
InterioY'Lot -
Corner Lot ❑
Reversed Corner Lot ❑
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ZBA Case # Date
BBA Case # Date
Building Insp. e' Approval
by g" . date
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Permit No. '-Date
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Distribution: Original - Applicant Bln - Offi ; Ca`na`ry-- Sales Tax: Pink - Applicants, Tag=•Bldg..lnsp. i.` � )
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Distribution: Original - Applicant Bln - Offi ; Ca`na`ry-- Sales Tax: Pink - Applicants, Tag=•Bldg..lnsp. i.` � )