HomeMy WebLinkAbout632 ENDICOTT ST - PERMITS - 12/22/198277-7477-7
ty 0f F0r't C0111115 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/,z ) el g~
Namef
c
Mail Address/-
3
O
Phone _ 7
Name �e_':i
0
Address/
oF7
/-. Ax, C f9 A
U
License No.
Phone �. 3 _7
g
°
Lot
Block
Filing Number
Q
y
Subdivision
0
PUD
d
J
DESCRIPTION OF WORK
vi,/ rt G XZ4 C,C
i rn t i e-!% Lr.. 7
Stock Options
Plan No. y 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.
sig end T f date
— CLASS OF WORK —
New Alteration Addition Demolish Move
❑ ❑ ❑ ❑ ❑
Plbg. Mach.,,...- Elec. Struct. Fire Prot.
❑ d7� ❑ ❑ ❑
Occ. Gr.ef 3 Type Const.
Use Zone
Use of Building
Height
Lot Area �
Frontage
Occ. Change from
=areaFin.
.
No. D.U.
a
Fin. Esmt. areallo.
Fireplaces or stoves
— RELEASES — Dates
Zoning
Engineering
Fire Department
Electric Department
Water & Sewer
Plan Review
Special Conditions:
Valuation
FEES
Permit
Plan Check
St. Oversizing
Water Plant Investment
Sewer Plant Investment
Storm Drainage
Electric Underground
City Sales Tax
,`? /I 'i
Total Fees
f'S e? . r 0
Permit No.
Date
0 95211
0
.t
,7.
ZBA Case#
Date
BBACase# '
Date
B 'ri Inysrp/' �d rApproval
date
Off -Street Parking
(No. Cars)
Interior Lot
❑
Corner Lot
❑
Reversed Corner Lot
❑
m
Ia
m
Cr
l I
t I
`m
ri7
>
rn
c
0
LL
"J
Street
Distribution' Original - Applicant, Blue - Office', canary - Sales Tax: Pink - Applicant Tag - Bldg. last,