KODIAK TWNST BK 1 LT 2 & 3 - ZCP 7/2/2026BUILDING DEPARTMENT KODIAK ISLAND BOROUGH APPLICATION FOR
LINES. PLEASE PRINT, USE BALL.POINT PEN,
BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY
(APPLICANT TO FILL IN ALL INFORMATION WITHIN HEAVY AND PRESS FIRMLY
BUILDING PERMIT NUMBER PIOT PLAN
(A S|TE PLAN MAY ALSO BE REQUIRED)
VALUAT ION : (BASIS)
SANITATION PLAN APPROVAL BY AN AOEC'CE
REGIUIREO PRIOR TO ISSUANCE OF A BUILOING
WATER ANO/OR SEWER IS NOT AVAILABLE F]
RTIFIEO INSTALLER IS
PERMIT WHERE PUBLIC
ROM A CERTIFICATEO 5T R EET
MUNIC IPAL SYSTEM
INSTALLER'S PLAN APPROVAL RECEIV NOTE: APPLICANT SHALL SHOW BUILDING SETBACKS
FROM PROPERTY LINES. AS PERPENDICULAR OISTANCES
FROM PROPERTY LINES TO BUILDING. DIMENSIONS OF
STRUCTURE SHALL BE SHOWN ON THE PLAN.
I NSTA LLE R
IOR TO THE ISSUANC PERMIT EITHER THE O THE
PROPERTY OR HIS AUTHORIZED AGENT MUST SIGN THIS APPLICATION OR
GRANT OTHER WRITTEN PERMISS!ON FOR THE OESCRIBEO WORK TO BE
PERFORMED
TAX LOT NO TE ZONING CODE COMPLIANCE
OWNE R
(FOR OFFICE USE ONLY: CIRCLE)zoN R ICT
OWNERSHIP TRANSFER REO. IN PROCESS. TO:
TYPE C UPANCY
I. OCCUPANCY GROUP
PER
(BY)NO. OF R IES TOT
CLOSING DATE, OEEO RECORDEO
AREA
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2. TYPE OF CONSTRUCTION C.U.P. OR VARIANCE
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APPROVED, BUILDING OFFICIAL APPROVED, ZONING OFFICER
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DATE ISSUED
BLOG PERMIT FEE t-2 6
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CLASS AND SCOPE OF WORK
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REPAIRALTE R AT ION
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PLAN CHK FEE
TOTAL
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NEAREST CROSS STREET
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INSPECTION SCHEDULENO. OF BUILDINGS NOW ON LOT
FLOO RS
PR IVATE
HGT
AD D IT ION
USE OF BUILDIN
OF BUILDING
NO. OF ROOMS
NO. OF FAM ILIES
WATER: PUBLIC
SIZE OF LOT
USE OF BUILOINGS
PR IVATESEWE R : PUBLIC
SPECIFICATIONS
NAM E
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MAILING AODRESS
ELECT R ICALPLUM B I NG
SEPT IC TAN K
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FI NAL
FINISH
MOTO RS
FIXTURESSEWE R
GAS
EACH OF THE ABOVE INSPECTIONS MUST BE REQUESTEO ANO THAT
PLASTER/BD
FIN ISH
W K PR FIEOG SSINGRTANYADtoTNALoWOKAPPOVEO
30roNSECTYR o R EAC HUBCBREQUoASNATHTPONoDBKA KTHEREQUITELPHONENNtoNSPECTHOUotc
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FLU ES
FINAL
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FRAME
BU ILD ING
FOUNDATION
NOTES:
TNSTALLATION oF (MINIMUM) t 8-INCH BY 2O'FOOT CULVERT lS REQUIREO
AT EACH ORIVEWAY ACCESS TO THE PROPERTY
TELEPHO N E
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STATE LICENSE NO.
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FURNACE, TYPE
I HEREBY ACKNOWLEDGE THAT I HAVE
READ THIS APPLICATION, THAT IT IS
CORRECT, AND THAT I AGREE TO COMPLY
WITH ALL O RD INANCES AND LAWS
REGULATING BUILDING CONSTRUCTION.
APPLICANT
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BUTLDTNG DEPARTMENT - C|TY / BOROUGH OF KODTAK
Applicant to fill in between heavy lines.
APPLICATION FOR BUILDING PERMIT AND CERTIFICATE
OF OCCUPANCY
DATE ISSUED
PLOT PLAN
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PLANNING & ZONING INFO
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TYPE OF OCCUPANCY
NUMBER OF STOR IES TOTAL HT
AREA OF LOT
FRONT YARD SETBACK FROM PROP. LINE
SIDE YARD SETBACK FROM PROP. LINE
REAR YARD
Approved: cHIEF BUILDING oFFlcAL Approved: zoNtNG ADMINISTRATOR
CLASS OF WORKBUILDING ADDRESS
DE MOL ISH
ALTE RATION REPA I R
BUILDING PERMIT NO
LOC AL IT Y
ADDIT ION MOVE
BLDG. FEE SNEAREST CROSS ST
USE OF BUILDING
SIZE OF BUILDING HE IGHT PLAN CHK. FEE
NO. OF ROOMS
MAIL ADDRESS
NO. OF FLOORS
VALUATION
TOTAL
NO. OF BUILDINGS BU!LDING PLUMB!NG ELECTRIC
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NO, OF BUILDINGS NOW ON LOT FOUNDAT I ON ROUGH ROUGHNAME
NO. OF FAMILIES F RAME SEPTIC TANK F IN ISH
SIZE OF LOT PLASTE R SEWE R F IX TU RES
ADD R ESS
USE OF BLDG. NOW ON LOT FLUES GAS MOTORSC ITY
SPECIFICAT!ONS F INAL F ITJ ISH FINAL
FOUNDAT!ONi
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DEPTH IN GROUND
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SI ZE SPA SPAN
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JOIST 2nd. FL
SUBDIV ISION
JOIST CEILING
EXTE RIOR STUDS
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INTERIOR STUDS
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EXTERIOR WALLS ROOF
INTERIOR WALLS REROOFING
FLUES
F I REPLACI FL. FURNACI
KITCHEN WATER HEATER
FURNACE orLGAS
DO NOT WRITE BELOW THIS LINE
2. Occupancy Group A, B, C, D, E,
F, G, H, l, J Div. L,2, 3,4,
3.FireZonel234
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Type of Construction
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this application and state that the
above is correct and agree to comply
with all City Ordinances and State
Laws regulating building constructiorl.
Applicant By By
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CLASS OF WORK
DEMOL ISH
BUI LDI NG ADDRESS
ALTE RAT ION REPA I R
BUILD!NG PERMIT NO
LOCALITY
ADDIT ION !MOVE BLDG. FEE s:.i,.t. l-! I i.lt.r\:, : i
usE oF BUILDING 5 t R
HETGHT /IS E BUIor LDI NG PLAN CHK. FEE
NO. OF ROOMS
MAIL ADDRES6
No. oF FLOoRS /
VALUATION
TOTAL
NO. OF BU|LD|NGS a ELECTR!CBUILDINGPLUMBINGCITYTEL. NO ?b//,
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NO. OF BUILDINGS T.r6W ON LOT /ROUGHFOUNDAT I ON ROUGH
NO. OF FAMTL|ES /
NAME
F IN ISHF RAME SEPTIC TANK
SIZE OF LOT 4370 F SEWE R F IXTU RESPLASTE RADD R ESS
USE OF BLDG. NOW ON LOT MOTORSFLUESGAS
SPECIFICATIONS
C ITY
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FOUNDATION
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DEPTH IN GROUND
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R.W. PLATE (SILL)
SIZE sPA.,SPAN
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JOIST lst. FL.
JOIST Znd. Fl"al
SUBDIV ISION
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EXTE RIOR STUDS
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INTERIOR STUDS
ROOF RAFTERS
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EXTERIOR WALLS ROOF
INTERIOR WALLS REROOFING
FLUES
F I REPLACE FL. FURNACE
WATER HEATERKITCHEN
orLFURNACEGAS
f hereby acknorvledge 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
DO NOT WRITE BELOW THIS LINE
, 2. Occupancy Group A, B, C, D, E,
I F, G, H, l, J Div. t,2, 3, 4,
3.FireZoneL234
)Type of Construction
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BUtLD|NG DEPARTMENT - CITY / BOROUGH OF KODIAK
Applicant to fill in between heayy lines.
APPLICATION FOR BU!LDING PERM!T AND CERTIFICATE
OF OCCUPANCY
DATE ISSUED
PLOT PLAN
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PLANNING & ZONING INFO
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TYPE Oi OCC UPANCY
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NUMBER oF sroRrEs U T()IAL HI
4AREA OF LOT
FRONT YARD SETBACK FROM PROP. LINE
SIOE YARD SETBACK FROM PROP. LINE (4.t7.l€s
REAR YARD '/*./,Approved: CHIEF BUILDING OFFICAL Approved: ZON ING ADMINISTRATOR'/W Q-1
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