LEITE ADD BK 2 LT 14 - Building PermitFURNACE, TYPE
BUILDING DEPARTMENT - KODIAK ISLAND B�-tou -H APPLICATION FOR BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY
(APPLICANT TO FILL IN ALL INFORMATION WITHIN HEAVY LINES. PLEASE PRINT, USE BALL-POINT PEN, AND PRESS FIRMLY.)
DATE ISSUED
SUBDIVISION/SURVEY
CLASS AND SCOPE OF WORK
NEW
DEMOLISH
LOT NO. BLOCK NO.
STREET ADDRESS
NEAREST CROSS STREET
W
NAME
(
H �
U W
W
z
U
cr Z
Q W
0111.
CONTRACTOR
MAILING ADDRESS
CITY, STATE// TELEPHONE
ALTERATION
REPAIR
ADDITION
MOVE
USE OF BUILDING
SIZE Of BUILDING HGT
NO. OF ROOMS FLOORS
NO. OF FAMILIES
NO. OF BUILDINGS NOW ON LOT
USE OF BUILDINGS
SIZE OF LOT
NAME
ADDRESS
CITY, STATE
STATE LICENSE NO.
NAyIE,
t .
ADDRESS
CITY, STATE
WATER: PUBLIC PRIVATE
BUILDING PERMIT NUMBER 6"40O
VALUATION: (BASIS)
SEWER: PUBLIC PRIVATE
SPECIFICATIONS
FOUNDATION
TYPE
DEPTH IN GND
AMOUNT
BLDG PERMIT FEE
PLAN CHK FEE
TOTAL
INSPECTION SCHEDULE
BUILDING
EXT
PIERS
FOUNDATION
FRAME
PLASTER/BD
FLUES
FINAL
PLUMBING
ROUGH
SEPTIC TANK
SEWER
GAS
FINISH
HGT FIN GRADE
P.T. PLATE (SILL)
STRUCTURAL
SIZE
SPA.
SPAN
GIRDERS
JOISTS 1ST FLR.
STATE LICENSE NO.
(FOR OFFICE USE ONLY: CIRCLE)
1. OCCUPANCY GROUP
A BEH I M R
DIVISION 1 2 3 4 5
2. TYPE OF CONSTRUCTION
I II III IV V
FR 1 -HR. N H.T.
SHEATHING, WALLS/EXT
WALLS
ROOF/CLG
JOISTS 2ND FLR.
JOISTS CLG
EXT STUDS
INT STUDS
ROOF RAFTERS
TRUSSES
BEARING WALLS
ELECTRICAL
ROUGH
FINISH
FIXTURES
MOTORS
FINAL
EACH OF THE ABOVE INSPECTIONS MUST BE REQUESTED AND THAT
WORK APPROVED PRIOR TO ANY ADDITIONAL WORK PROGRESSING
BEYOND THAT POINT, A5 REQUIRED BV UBC SECTION 305. FOR EACH
INSPECTION, 24 HOURS NOTICE IS REQUIRED. TELEPHONE THE KODIAK
ISLAND BOROUGH ENGINEERING DEPARTMENT, 486-5736, EXT. 273.
NOTES:
INSTALLATION OF (MINIMUM) 18 -INCH BY 20 -FOOT CULVERT IS REQUIRED
AT EACH DRIVEWAY ACCESS TO THE PROPERTY.
SANITATION PLAN APPROVAL BV AN ADEC-CERTIFIED INSTALLER 15
REQUIRED PRIOR TO ISSUANCE OF A BUILDING PERMIT WHERE PUBLIC
WATER AND/OR SEWER 15 NOT AVAILABLE FROM A CERTIFICATED
MUNICIPAL SYSTEM.
INSTALLER'S PLAN APPROVAL RECEIVED
INSTALLER
INSULATION, FNDN
ROOF FLOOR
FINISH, EXT WALLS
ROOF
FLUES, FIREPL WOOD HTR
KITCHEN WATER HTR
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
PRIOR TO THE ISSUANCE OF A PERMIT, EITHER THE OWNER OF THE
PROPERTY OR HIS AUTHORIZED AGENT MUST SIGN THIS APPLICATION OR
GRANT OTHER WRITTEN PERMISSION FOR THE DESCRIBED WORK TO BE
PERFORMED.
TAX LOT NO DATE
OWNER PER
OWNERSHIP TRANSFERRED, IN PROCESS, TO:
PER
CLOSING DATE, DEED RECORDED (BV)
APPROVED, BUILDING OFFICIAL
BY
PLOT PLAN
(A SITE PLAN MAY ALSO BE REQUIRED)
REAR PROPERTY LINE
SIDE PROPERTY LINE
1
FRONT PROPERTY LINE
SIDE PROPERTY LINE
STREET
NOTE. APPLICANT SHALL SHOW BUILDING SETBACKS
F ROM PROPERTY LINES, AS PERPENDICULAR DISTANCES
FROM PROPERTY LINES TO BUILDING. DIMENSIONS OF
STRUCTURE SHALL BE SHOWN ON THE PLAN.
ZONING CODE COMPLIANCE
ZONING DISTRICT
TYPE OF OCCUPANC
NO. OF STORIES
TOTA
GT r
AREA OF T
SETBAC
OPERTY LI ES:
FRON
REA
SIDE L) ! SIDE (R)
REQ'. OFF-STREET PARKING
C.U.P. OR VARIANCE/if)
c; Flt" (_: %'; /C7 Com.
APPROVED, ZONING OFFICER
BY