ERSKINE ADD BK 8 LT 74 - ZCPKodiak island Borough
Community Development Department
710 Mill Bay Rd. Rm 205
Kodiak AK 99615
Ph. (907) 486 - 9362 Fax (907) 486 - 9396
http: / /www.kodiakak.us
Zoning Compliance Permit
Permit No. c
Subrriit'by Emai
Property Owner / Applicant:
Mailing Address:
Phone Number:
Other Contact email, etc.:
Legal Description:
Street Address:
Use & Size of Existing Structures:
The following information is to be supplied by the Applicant:
�1- L9 -co.a ar:ir&P.A. boy
W.L N Imo- 1-) #1A-AC-
4 (1 u k. a k`11. , K.%(tU( 4.51 90b1S'
0 ► p F- •-fiN S -C 4 Li‹
K.1- UT ((-\ -ry - a -r
Description of Proposed Action:
Site Plan to include: Lot boundaries and existing easements, existing buildings, proposed location of new construction, access
points, and vehicular parking areas.
Staff Compliance Review:
Lot Area:
Front Yard:
Prk'g Plan Rvw?
Plat / Subdivision
Requirements?
ZONING:
Lot Width:
Rear Yard:
# of Req`d Spaces:
Parcel No.
Bld'g Height:
Side Yard:
Does the project involve If YES, do you have an EPA Return Receipt of Notification?
an EPA defined facility? "Permit will not be issued until receipt is submitted to KW"
Coastal Policy
Subd Case No.
Driveway
Permit?
Septic Plan
Approval:
Fire
Marshall:
Consistent?
Plat No.
Attachment?
Bld'g Permit No.
Applicant Certification: I hereby certify that I will comply with the provisions of the Kodiak Island Borough Code and that
have the authority to certify this as the property owner, or as a representative of the property owner. I agree to have identifiable
corner markers in place for verification of building setback (yard) requirements.
Attachments? List Other:
Date: O 71 GlQ ■
Signature: . ',` o
r 6 catit' eon/
This permit is only for the proposed project as described by the applicant. 'if there are any changes to the
proposed project, including its intended use, prior to or during its siting, construction, or operation, contact
this office immediately to determine if further review and approval of the revised project is necessary.
"EXPIRATION: A zoning compliance permit will become null and void if the building or use authorized by such permit is not
commenced within 180 days from the date of issuance, or if the building construction or use is abandoned at anytime, after the
work is commenced, for a period of 180 days. Before such work can be recommenced, a new permit must first be obtained. (Sec.
106.4.4 Expiration. 1997 UBC) per KIBC 17.03.060. **
CDD Staff Certification
Date:
CDD Staff:
Payment Verification
Zoning Compliance Permit Fee
Payable in Cashier's Office
Room # 104
Construction Disposal Deposit
Payable in Cashier's Office
Room # 104
Fee Schedule
I 4iou ?o Li
APPLICATION FOR BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY — CITY OF KODIAK — KODIAK ISLAND BOROUGH — BUILDING DEPARTMENT
Telephone: 486 -8070 • 486 -8072 Fax: 486 -8600 710 Mill Bay Road, Room 208
(APPLICANT TO FILL IN ALL INFORMATION WITHIN BOLD LINES. PLEASE PRINT. USE A BALLPOINT PEN AND PRESS FIRMLY.
(OFFICE USE ONLY)
STREET ADDRESS:
4‘i I` /i ii,A _ k'- ty° i ! C)
CLASS AND SCOPE OF WORK:
€'} i- i,1-41 ,-,1,:-- Oikt:-1 /21 I •'i 0 A
SPECIFICATIONS:
BUILDING PERMIT NUMBER:
DATE OF APPLICATION:
r P ^ i
LOT: ` BLOCK:
' ? < }r a h ��ti't -'7
NEW
DEMOLITION
FOUNDATION
FOOTINGS
STEM WALL
PIERS
ZONING COMPLIANCE: " '-
DATE ISSUED:
i_ 1
(---,- f - !
ALTERATION
REPAIR
TYPE
SUBDIVISION / SURVEY:
t 1 ",ti-i1---& 14.4i) j'a'i Ki
ADDITION
MOVE
DIMENSIONS
VALUATION BASIS:
BUILDING PERMIT FEE:
1 C-
DEPTH IN GRND
O
W
N
E
NAME:
Qts =5 -rcro t e c gnu
USE OF BUILDING AUTHORIZED BY
THIS PERMIT:
A001 ��°�f -' C.-110 n�Y 4
p c G✓rUo(4/ lei ...Jr,. 1
le- aor*j ,
REINFORCEMENT
VALUATION: " ` /`"
PLAN CHECK FEE: ` "
'7' (-
s
BOLT SPACING
MAILING ADDRESS:
411 SctAi.As` , L'4 at)
CRAWL SPACE HEIGHT INCHES
OCCUPANCY—.
TOTAL FEE:
GROUP:
rr
,\
CRAWL SPACE VENT SQ. FEET
A B E F H I M �S U
•.. ,-,
DIV. 1 2 (3 4 5 6
0
CITY & STATE: 1
1:u $a G. E
SIZE HEIGHTS
STRUCTURAL
SPECIES & GRADE
SIZE
SPACING
SPAN
NO. OF ROOMS STORIES
RECEIPT NO:
TELEPHONE:
- I • --, - - �i
NO. OF FAMILIES
GIRDERS
TYPE OF BUSINESS
GIRDERS
EACH OF THE FOLLOWING
STAGES OF CONSTRUCTION
REQUIRES INSPECTION BE •
REQUESTED & COMPLETED •
PRIOR TO PROCEEDING WITH
ANY FURTHER WORK:
FOR INSPECTION CALL 486 -8070
A
R
C
HCITY
E
N
G
NAME:
NO. OF BLDGS NOW ON LOT
JOISTS 1ST FLOOR-
USE OF EXISTING BLDGS
JOISTS 1ST FLOOR
MAILING ADDRESS:
SIZE OF LOT
JOISTS 2ND FLOOR
WATER: PUBLIC
PRIVATE
I
1
JOISTS 2ND FLOOR
TYPE OF CONSTRUCTION
I II III IV;
1 -HR FR H.T.
& STATE:
SEWER: PUBLIC
PRIVATE
CEILING JOISTS
INSULATION TYPE & THICKNESS:
EXTERIOR WALLS
TELEPHONE:
FOUNDATION
BEARING WALLS
INTERIOR WALLS
EXCAVATION
STATE LICENSE:
WALLS
ROOF RAFTERS
UNDERGROUND UTILITIES
ROOF / CEILING
TRUSSES
DRIVEWAY PERMIT:
FOUNDATION / SETBACKS
.aZ.¢Qot-occ 1
NAME:
SHEATHING TYPE & SIZE:
FURNACE TYPE:
SUBMITTED
FRAMING
FLOOR
APPROVED
ROUGH ELECTRICAL
MAILING ADDRESS:
WOOD HEATER YES NO
TYPE
ROUGH PLUMBING
WALLS j
ADEC APPLICATION:
FINAL
DATE C.O. ISSUED:
SUBMITTED I
CITY & STATE:
ROOF t» /ar_ 1 .I IOW
'
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION,
THAT IT IS CORRECT AND THAT I AGREE TO COMPLY WITH ALL
ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCTION
APPLICANT: �" . , r
f e i , t, ,yqq
FINAL APPROVAL ' 1
TELEPHONE:
FINISH MATERIAL:
ALASKA FIREMARSHAL REVIEW:
SUBMITTED: APP13L-}VgD—
ROOF rte-- Of - ;
FOR
DATE
M
,IMPORTANT MESSAGE) ,
•
etticS (DI et°,
OF
PHONE
0 FAX
LI MOBILE
45 — 2-- 2—
AREA CODE .
NUMBER EXTENSION
AREA CODE
NUMBER
TIME TO CALL
.
TELEPHONED
,
PLEASE CALL -
X
_
' CAME TO SEE YOU •
WILL GALL AGAIN
-
, WANTS TO SEE Y01.1
- •.,
RUSH
RETURNED YOUR CALL
SPECIAL ATTENTION
MESSAGE
eti u..4 s L'o re. CAJCP 0 64...+-. =00 4.%11.1%., , .
(...)
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Car\ calaoL4-7-' Ty-N) -FICK
a.t.
SIGNED
_
FORM 3002P
WWI LITHO IN U.S.A.
APPLICATION FOR BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY - CITY OF KODIAK - KODIAK ISLAND BOROUGH - BUILDING DEPARTMENT
Telephone: 486 -8070 • 486 -8072 Fax: 486 -8600 710 Mill Bay Road, Room 208
APPLICANT TO FILL IN ALL INFORMATION WITHIN BOLD LINES. PLEASE PRINT. USE A BALLPOINT PEN AND PRESS FIRMLY.)
l 01615 (OFFICE USE ONLY)
STREET ADDRESS:
CLASS AND SCOPE OF WORK:
SPECIFICATIONS:
BUILDING PERMIT NUMBER:
DATE OF APPLICATION:
LOT: BLOCK:
NEW
DEMOLITION
FOUNDATION
FOOTINGS
STEM WALL
PIERS
ZONING COMPLIANCE:
DATE ISSUED:
ALTERATION
REPAIR
TYPE
SUBDIVISION / SURVEY:
: Ps -1N(-
ADDITION
MOVE
DIMENSIONS
VALUATION BASIS:
BUILDING PERMIT FEE:
DEPTH IN GRND
O
W
N
E
R
NAME:
USE OF BUILDING AUTHORIZED BY
THIS PERMIT:
REINFORCEMENT
VALUATION:
PLAN CHECK FEE:
BOLT SPACING
CRAWL SPACE HEIGHT INCHES
OCCUPANCY
TOTAL FEE:
MAILING ADDRESS:
GROUP:
CRAWL SPACE VENT SQ. FEET
A B E F H I M R S U
DIV. 1 2 3 4 5 6
CITY & STATE:
SIZE HEIGHT
STRUCTURAL
SPECIES & GRADE
SIZE
SPACING
SPAN
NO. OF ROOMS STORIES
RECEIPT NO:
TELEPHONE:
NO. OF FAMILIES
GIRDERS
EACH OF THE FOLLOWING
STAGES OF CONSTRUCTION
REQUIRES INSPECTION BE
REQUESTED & COMPLETED
PRIOR TO PROCEEDING WITH
ANY FURTHER WORK:
FOR INSPECTION CALL 486 -8070
TYPE OF BUSINESS
GIRDERS
A
R
C
H
E
N
G
NAME:
NO. OF BLDGS NOW ON LOT
JOISTS 1ST FLOOR
USE OF EXISTING BLDGS
JOISTS 1ST FLOOR
MAILING ADDRESS:
SIZE OF LOT
JOISTS 2ND FLOOR
WATER: PUBLIC'
1 PRIVATE
'
JOISTS 2ND FLOOR
TYPE OF CONSTRUCTION
I
I II III IV V
N 1-HR FR H.T.
& STATE:
SEWER: PUBLIC
PRIVATE
CEILING JOISTS
INSULATION TYPE & THICKNESS:
EXTERIOR WALLS
FOUNDATION
BEARING WALLS
TELEPHONE:
INTERIOR WALLS
EXCAVATION
UNDERGROUND UTILITIES
STATE LICENSE:
WALLS
ROOF RAFTERS
DRIVEWAY PERMIT:
FOUNDATION / SETBACKS
ROOF / CEILING
TRUSSES
SUBMITTED
FRAMING
O 0 Z CC Q U H 0 C
NAME:
SHEATHING TYPE & SIZE:
FURNACE TYPE:
FLOOR
APPROVED
ROUGH ELECTRICAL
WOOD HEATER YES NO
TYPE
ROUGH PLUMBING
MAILING ADDRESS:
ADEC APPLICATION:
FINAL
WALLS
SUBMITTED
DATE C.O. ISSUED:
CITY & STATE:
ROOF
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION,
THAT IT IS CORRECT AND THAT I AGREE TO COMPLY WITH ALL
ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCTION
_ APPLICANT:
FINAL APPROVAL
ALASKA FIREMARSHAL REVIEW: 3
4
SUBMITTED: AP ED: `S4^,
TELEPHONE:
FINISH MATERIAL:
ROOF
APPROVED - BUILDING OFFICIA C° `. • -
STATE LICENSE:
EXTERIOR SIDING
INTERIOR WALLS
NOTES: N' , 9
Or, y1,
tc, 4-1/
c4eC1 9
��/
Rev. 1 -97
PRINTED IN KODIAK, ALASKA BY C&A PRINTING, INC.
APPLICATION FOR BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY - CITY OF KODIAK - KODIAK ISLAND BOROUGH - BUILDING DEPARTMENT
Telephone: 486 -8070 710 Mill Bay Road
(APPLICANT TO FILL IN ALL INFORMATION WITHIN BOLD LINES. PLEASE PRINT. USE A BALLPOINT PEN AND PRESS FIRMLY.)
(OFFICE USE ONLY)
STREET ADDRESS:
CLASS AND SCOPE OF WORK
SPECIFICATIONS:
BUILDING PERMIT NUMBER;
DATE OF APPLICATION:
LOT: BLOCK:
NEW
DEMOLITION
FOUNDATION
FOOTINGS
STEM WALL
PIERS
ZONING COMPLIANCE:
DATE ISSUED:
ALTERATION
REPAIR
TYPE
SUBDIVISION / SURVEY:
ADDITION
MOVE
DIMENSIONS
VALUATION BASIS:
BUILDING PERMIT FEE:
DEPTH IN GRND
O
r E
Ors!
R
NAME
USE OF BUILDING AUTHORIZED BY
THIS PERMIT:
a- = .-:. - {%['
REINFORCEMENT
VALUATION:
PLAN CHECK FEE;
BOLT SPACING
MAILING ADDRESS:
CRAWL SPACE HEIGHT INCHES
OCCUPANCY GROUP:
TOTAL FEE:
A B E H 1 MR
DIV. 1 2 3 4 5 6
/ 7
SPACE VENT SQ. FEET
CITY & STATE:
SIZE HEIGHT
STRUCTURAL
SPECIES & GRADE
SIZE
SPACING
SPAN
NO. OF ROOMS STORIES
RECEIPT NO: < '1
TELEPHONE:
NO. OF FAMILIES
GIRDERS
EACH OF THE FOLLOWING
STAGES OF CONSTRUCTION
REQUIRES INSPECTION BE
REQUESTED & COMPLETED
PRIOR TO PROCEEDING WITH
ANY FURTHER WORK:
FOR INSPECTION CALL 486 -8070
TYPE OF BUSINESS
GIRDERS
A
R
C
H
E
N
G
NAME:
NO. OF BLDGS NOW ON LOT
JOISTS 1ST FLOOR
` �
USE OF EXISTING BLDGS
JOISTS 1ST FLOOR
MAILING ADDRESS:
SIZE OF LOT
JOISTS 2ND FLOOR
WATER: PUBLIC
PRIVATE
JOISTS 2ND FLOOR
TYPE OF CONSTRUCTION
I II III IV V
N 1 -HR FR H.T.
CITY & STATE:
SEWER: PUBLIC
PRIVATE
CEILING JOISTS
INSULATION TYPE & THICKNESS:
EXTERIOR WALLS
TELEPHONE:
FOUNDATION
BEARING WALLS
INTERIOR WALLS
EXCAVATION
STATE LICENSE:
WALLS
ROOF RAFTERS
UNDERGROUND UTILITIES
ROOF / CEILING
TRUSSES
DRIVEWAY PERMIT:
FOUND/NT-LPN i 40fElACKS
SUBMITTED
FRAMING
C
Ny.1
T
R
A
C
T
O
R
NAME:
SHEATHING TYPE & SIZE;
FURNACE TYPE:
FLOOR
APPROVED
ROUGH ELECT AL
WOOD HEATER YES NO
1NFE
ROUGH PLUI 9
MAILING ADDRESS:
WALLS
ADEC APPLICATION:
FINAL Paid
D C.04.-AW,B1Wrtment
SUBMITTED
CITY & STATE:
ROOF
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION,
THAT IT IS CORRECT AND THAT I AGREE TO COMPLY WITH ALL
ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCTION
APPLICANT:
FINAL APPROVAL
City °f KorSlak
TELEPHONE:
FINISH MATERIAL:
ALASKA FIREMARSHAL REVIEW:
SUBMITTED: APPROVED:
ROOF
APPROVED - BUILDING OFFICIAL:
STATE LICENSE:
EXTERIOR SIDING
INTERIOR WALLS
NOTES: 3 C 6.3 ' c G c, r, ,', c , T r , UTILITY CONNECTION FEE
/L. 1 2- gip/ WATER $ DATE
SEWER $ RECEIPT #
TOTAL $ CASHIER
Curb & Gutter
i
Other
TOTAL
',—/
I
Net + (--)
VALL":.
YEAR` 1
VIM"
I •
)ci7J-1
1
• •
(
ci)
15'3
199
OWN FR
OwNEA
ASSESSED VALUATION
Slags.
otal
ERiG CP-CR./XI
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7 11 z-
KODIAK
710
ISLAND BOROUGH Community Development
Mill Bay Road (Rm 205 Kodiak, Alaska 99615 -6340 - Phone: (907) 486 -9362
ZONING COMPLIANCE
FEE: $9.00
PERMIT Permit #: e_ z_ qS— O3_2.,
0
0
3.
. Property Owner /Applicant: - / V P s4-0,
12_
Number and .ze of ;�,: rking_s� aces required (onsite identification of parking spaces is required - Yes:
$10 ' ... f r . 7�e-@� I :
��, , �ti (1\,
No: )
pp nn / /rte
Mailing Address: V7 6Y 2-7-3( . �X c 4�t� Phone: 7� `O 2-67 i Z--
O-U -c-2� .
.� .:= = �1 l ,,,,r 2 -
/- 'n /� �%
Legal Description: U + '4-4 t31 �d<-- (-V51�c) — 644c0c �
G 1 ��
Off- street loads g requirement: NI/
(ft �
j
Tax Code #: 2 � � LIDO �b �
`�
Plat related requirements (e.g., plat notes, easements, subdivision conditions, etc.): /C /�T'
Street Address: B !� {�� 4%
Description of Existing Propertyicurrentzoning:
2 % — TW aµ� s4 eP€
Minimum Required Lot Area: - 2-cDC
Width: (.c' C)
Other requirements (e.g., zero lot line, additional setbacks, projections into yards, screening, etc.):
�/ // /
firo- - �P/ i' d
Actual Lot Area: �� %
\
UUUU`'
6 uw� l
Width: / ;�
Gtli ,�� ...-12. re.A �� 1 rt�v �:Cn. l-(
Minimum Required Setbacks: Sides: /D
SZ /
Ii'Zc.1!fii.1
)'�? �l </ J 5�' `S s��4J
Rear: Th J2
v C `��'�5 � U
Coastal anagement Program Applicable Polices (check appropriate category) - Residential:
v
Business:
�7
Front: _
Maximum Building Height: ‘-)
Industrial: Other (list):
Use and size of existing structures on the lot: c , VC (�
/ %t e-
� /1
Is the proposed action consistent with the KIB Coastal Management Program? - Yes: /�J No:
J
If the proposed action conflicts with the Coastal Management Program policies, attach a sheet that notes the policy(ies),
describes the conflict(s), and specifies conditions to mitigate the conflict(s). Attachment - Yes: No:�
9� 2
Description of proposed action (attach site plan):
sT1,2164S_ Rod M r a vo000.1. OVc.ig.
A
, ��•Il?�� : Iris /
ti C-�
�.� �.,;,__.-
a V r (- 'C
F - P I 10\i) M/1/
/ / , A4 J i 01;nt
yF Air EM - Ib 1�_ / .
_
1 :/1, Ix, '&ti
• -4) / Lam/ -t •/ �c-9 a s
a�Iu • • - /
(' , D 0_ '. f/ ..LPL h< (C ,
/
Applicant Certification: I hereby certify that I will comply with
I agree to have identifiable corner markers in place in the field for verification
pl,.
the provisions of the Kodiak Island Borough Code and that I have the authority to certify this as the property owner, or as a representative of the property owner.
of setbacks.
. Date: 1/45 ` 1 7 f `- Title: 0'...g 1� �' 0000030 n000l i99t
�y
By: --. A ¢ ` ..-21J /
Supporting documents attached c eck) e plan: V
�c.
As -built survey:_ Fa' Other (list): f' 16,ttt1' i�.A•7o`a1t�51P r+./4-0 ' `(i i t N ) �i;h' ,fie f `..14' j 50
/
, tlu LLB
`
'\ ;" lir FO�u }i LIfi1: ;
6.
Community Development staff for zoning, by:
<GArit � Date: 61(-7 ) et. c-----
Title: C/121 3
;1
ifs
fr
°i
%.
Fire Chief [City of Kodiak, Fire District #1 (Bayside), Womens Bay Fire District] approval for UFC (Sections 10.207 and 10.301C)
3ii10 950 :55 BobQ0:3�
f�AID 000
by: �i2F.F �(]�,� Date. • ZGP
LIP�� ni
$.
Driveway Permit (state, City of Kodiak, Borough) issued by: Date:
its
i#3
9. Septic system PLAN approved by: flit Date:
Distribution: File /Building Official /Applicant/AssessingTH IS FORM DOES NOT AUTHORIZE CONSTRUCTION WHEN A BUILDING PERMIT IS REQUIRED
July 1992
AS • BUILT .SURVEY
1 hereby certify that 1. have surve gd the following described property:
107 74, a-Z ck 8� E, b,,e $i/i visio 2 ? U. S,
.5urvdy 5ra2 /0 /0' /lumber 60 -8, .diak
R'ccor 1/i 231/.56-4/c74
and that the improvements situated thereon are within the property lines
and do not overlap or encroach on the property lying adjacent thereto.
that no improvements on property lying adjacent thereto encroach on
the premises in question and that there are no roadways, transmis-
sion lines or other visible easements on said property except as indi-
cated hereon.
Dated thi S" day / /1/ 19 97.i
/� /
ROY A. ECKLUN
Registered Land Surveyor
Drawn by: 124 /67-4 TDate: 24 TUNE 1992
Kodiak Island Borough Community Development Department
ZONING COMPLIANCE PERMIT
1. Property Owner/Applicant
S 4)ti,n
Name:
Mailing address:
) (.∎ ' k1508 O) Zoning Compliance #: C 09 SO2 .
/c)f i07 / ?e O Lk)ic
Telephone #: / S-6-33 /
2. Zoning Requirements for New Construction - Description of Proposed Action (attach site plan)
Use of proposed structure(s)• AV /1\ r1 �u� ASO TO
1.0 ).5- h cc -6SSo .
Road access for emergency vehicles: Yes /" No Date L[
T�-
(contact Fire Chief for confirmation)
Water supply adequate for public use, insti utional use, commercial, and residential
structures larger than a triplex: Yes No Date PGe__
(contact Fire Chief for confirmation)
Lot area: / °/ ZZ ' 4 Lot width: �iPc rrsC (Ws(
Minimum setbacks - Front: 02,5 l Rear: / 0(
Sides - Left: 4-( Right csl
Maximum building height
Maximum lot coverage: i
a � ref ci
Number and size of parking spaces required.
Off - street loading requirement ,f 6
,t
Plat related requirements: i 1
Other (e.g. zero lot line, additional setbacks, projections into yards, screening, etc.):
7. Borough Staff App
Signed:
3. Legal Description of Property
Street address. 411/ ufO- V ii/k, v/. ( ' �L
J
Lot, Block, Subdivision: �.� )C 1Z E
Survey, other (e.g. Township /Range): Tax Code #. ki14(°°11.07-Cto
4. Description of Existing Property
Minimum Area: % Zoo -Y
(22sc?Xw.. W/
v [[[[1111 a, S Z c
201k. 2sTi )
Zoning:
6176/
Minimum Lot Width.
Use and size of existing b uildings on the lot
b
. 1 U.! CI
5. Consistency with Coastal Management Program
Applicable policies - Residential: Business: Industrial.
Other.
Proposed action consistent with Borough Coastal Management Program - Yes: No
If proposed action conflicts with Coastal Management Program policies, attach a sheet that notes the policy(ies), describes
the conflict(s), and notes the condition(s) attached to the consistency approval to mitigate these conflicts.
Attachment - Yes No
6. Applicant Certification
I hereby certify that I will comply with all provisions of the Kodiak Island Borough Code and that I have the authority to
certify this as owner, or representative of the owner, of the property involved. I agree to have corner markers in place for
verification of setbacks.
Signed.
Owner:
Date.
Support Documents Attach
As Built Survey: Other
Title: Yyk/1/4.,V—
Date.
THIS FORM DOES NOT AUTHORIZE CONSTRUCTION WHEN A
BUILDING PERMIT IS REQUIRED
Distribution:
White to File
Yellow to Building Official - Pink to Applicant
Kodiak Island Borough Community Development Department
710 Mill Bay Road (Room 204), Kodiak, Alaska 99615 -6340. Phone (907) 486 -5736, extension 255. July 1, 1988