HomeMy WebLinkAbout05050020-ApplicationCOMMERCIAL or INSTI.,T}{. ,TIONAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Commercial or Institutional, New Structures, Additions, Remodels, Tenant Finishes, & Accessory Buildings
BUZLDER of
RECORD:
PROPERTY
OWNER:
~ PRO3ECT
INFO:
STREET ADDRESS ~
ll
PHONE
PHONE
STATE
ADDRESS OF CONSIRUCT~ON SUITE# (If Applicable)
FAX
Address of Shell E
OR TENANT NAME:
FAX
SCOPE(S) OF
RELEASE:
WpR~,~UT[UTy SEWER UI~HTY
ER: PROVIDER:
Lot # and Su~ivision (If Appficable)
C3 SPKLR OTHER(S):__
ESTIMATED
(EXCLUDING LAND VALUE)
J
)0o0 )19 I
SQUARE
mOT^GE: /
/ BZA / BPW DOCKET NUMBERS; AND/OR
COUNTY WELL AND/OR SEPTIC PERMIT #~ (If Applicable):
#of Roots: Elevator or Uft: O YES
E=F ~ : -.: TYP -MPR VE-
~' COMHERC~AL ~:~ ~S~ []~ ~C)r'~(~'~bIE}AL~ Early Release _f Manufactured
(privatelyowned~-, . (~ ~1~1 t~J Permit: Y ' _N/ Trusses.
arec~mmercla) r~ c:~ , j' ~ ~_.~" LotSp t Y 'FN SumpPump: _Y - N
STTTUH NAL ~ ~,,, ~,,/, .~ ~ s ~3, Mez~r4~e~~ Peck Does any part of the property lie within a special Flood
C] Municlpal/t~:- Bldg~
0 ~ Ci~'OF~ /~,~:~v!t::l_ ~A~N~I~P designation area: Y~
O Church
State License #:
0 POST&BEAM 0 BASEMENT
(or POST & PIER) WALKOUT:YN
time frames for
~hereto, I ~urcher certify that only
~ot be used or occupied until a Ceddflcat¢ o£
Print
USE ONLY: ************************************************************************
OFF~CE ~ ~
INSPECT/ONS REQUZRED: ~,J, . Filing Fees: -- -
# Charged Re-
Upper Footing Lower Footing Under Slab ~\ Base Inspections: Reviews
Site Cert. of Occupancy: t .~-----
Meter
Base
v AddRionaJ Fees
Date) ,eceived by: