ELDERBERRY HGTS 1ST BK 2 LT 6 - Other Agency PermitsAPPL T!ON FORTCERTIFICATE R OF REGISTR N �26212s ..?7\ AND
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TO: CITY OF KODIAK
P.O.BOX 1397
KODIAK, ALASKA 99615
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DATE OF APPLICATION
ACCOUNT NO.
NAME OF FIRM `" a u x 6 /-t.
a Q S
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LOCATION ADDRESS 67/ A-to Z Q rY e BUSINESS PHONE WO -6-7--57.2
MAILING ADDRESS
NAME OF OWNER
STREET CITY
A1-14 x /10 I Tat Ito -Q
STATE ZIP CODE
HOME ADDRESS .c // �� z a p71--- (� �� �� I� �i �
TYPE OF BUSINESS
/600-t,,. �t
DATE BUSINESS STARTED
HOME STREET CITY TATE CODE
ALASKA BUSINESS LICENSE NUMBER
TYPE OF ORGANIZATION: INDIVIDUAL
PARTNERSHIP
l]
CORPORATION
OTHER (EXPLAIN BELOW)
IS BUSINESS SEASONAL "'� IF YES, APPROXIMATE DATES THAT BUSINESS IS OPERATED EACH YEAR
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NO. OF MONTHS
/ S GNATURE & TITLE OF APPLICANT
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NAME TITLE
MAILING ADDRESS: HOME ADDRESS: PHONE:
NAME TITLE
MAILING ADDRESS: HOME ADDRESS: PHONE:
NAME TITLE
MAILING ADDRESS: HOME ADDRESS: PHONE:
NAME TITLE
MAILING ADDRESS: HOME ADDRESS: PHONE:
REVENUE OFFICE
TEL. NO.
NAME
BUILDING DEPARTMENT — CITY / BOROUGH OF KODIAK
Applicant to fill in between heavy lines.
CLASS OF WORK
DUNG ADDPI SS
LOCALIT,,
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MAIL ADDRESS
CITY
CONTRACTOR
NAME
ADDRESS
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CITY
STATE LICENSE NO.
NAME
ADDRESS
CITY
STATE LICENSE NO.
SUBDIVISION
LOT NO.
I3LK
DO NOT WRITE BELOW THIS LINE
IPType of Construction
I, II, III, IV, V, VI
2. Occupancy Group A, B, C, D, E,
F, G, H, I, J Div. 1, 2, 3, 4,
3. Fire Zone 1 23 4
NE _W
DEMOLISH
ALTERATION
REPAIR
ADDITION
MOVE
USE OF BUILDING
SIZE OF BUILDING
HEIGHT
NO. OF ROOMS
NO. OF FLOORS
NO. OF BUILDINGS
NO. OF BUILDINGS NOW ON LOT
NO. OF FAMILIES
SIZE OF LOT r
USE OF BLDG. NOW ON LOT
SPECIFICATIONS
FOUNDATION
MATERIAL
EXTERIOR
PIE RS
WIDTH OF TOP
WIDTH OF BOTTOM
DEPTH IN GROUND
R W PLATE (SILL)
SPA.,.
SPAN
GIRDERS
JOIST Ist. FL.
JOIST 2nd. FL
JOIST CEILIN
E XTE RIOR STUDS
INTERIOR STUDS
ROOF RAFTERS
BEARING WALLS
COVERING
EXTERIOR WALLS ROOF
INTERIOR WALLS REROOFING
FLUES
FIREPLACE FL. FURNACE
KITCHEN WATER HEATER
URNACE
GAS 011
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.
Applicant
APPLICATION FOR BUILDING PERMIT AND CERTIFICATE
OF OCCUPANCY
BUILDING PERMIT NO
VALUATION
s
BUILDING
FOUNDATION
FRAME
PLASTER
FLUES
FINAL
DATE ISSUED
HLDO
PLAN CHK. FEE
TOTAL
PLUMBING
ROUGH
SEPTIC TANK
SEWER
GAS
FINISH
ELECTRIC
ROUGH
FINISH
FIXTURES
MOTORS
FINAL
3N11 Al83dO2 d
PLOT PLAN
A
I
SETBACK
3N11 Ala3dO8d
STREET
PLANNING & ZONING INFO.
ZONING DISTRICT
TYPE OF OCCUPANCY
NUMBER OF STORIES TOTAL HT.
AREA OF LOT
FRONT YARD SETBACK FROM PROP. LINE
SIDE YARD SETBACK FROM PROP. LINE
REAR YARD
Approved: CHIEF BUILDING OFFICAL Approved: ZONING ADMINISTRATOR
By: By: