HomeMy Public PortalAbout9162 LA ROSA DR_Certificate of Occupancy__ 76A662-C E992-4/77
:'. APPLICATION FOR OCCUPANCY INSPECTION
FOR APPLICANT TO FILL IN BUILDING
(Print or type only). # ADDRESS Z
BUILDING LOCALITY
'
ADDRESS �� �15/9, 'q c
/� NEAREST
CITY e /4p -Ci T ZIP 9t-7 k0 CROSS ST.
SIZE OF LOT NO. OF BLDGS. ASSESSOR
(} )( ZaZJ NOW ON LOT MAP BOOK PAGE PARCEL
DISTRICT TYPE FIRE SED Y
TRAC ;;� BLOCK ;LOT NO. � A O CONST. _ ZONE
�`
OWNER TEL .
NO. USE ZONE MAP
NO.
ADDRESS
1 SPECIAL'
CITY ZIP
CONDITIONS
K
BLDG.SET BACFROM
SIZE OF . NO.OF' FRONT-PROP. LINE-OF (STREET)
EXISTING BLDG. STORIES s.
HIGHWAY + YARD = TOFRONT OP. LIN FROM IGHWAYPE 'MDT c
PRESENT USE OF BUILDING FRONT PROP. LINE HIGHWAY vnorH
+ _
BLDG.SET BACK FROM
NO. PARKING SIDE PROP•'LINEOF (STREET)) V
SPACES PROVIDED
TOTAL SET BACK FROM TYPE OF oclsrwc
HIGHWAY + YARD– SIDE PROP. LINE` HIGHWAY WIDTH Z
O
REASON FOR INSPECTION REQUEST + – W
CORNER CUTOFF YES NO Z
S OCCUPANCY GROUP
AS VERIFIED — OCCUPANT,
I LOAD
EXIT HARDWARE:
PROPOSED MAX.OCC. KNO
E
NO SPC. KNOWL.
NO.OF EXITS ❑
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS PANIC DEVICES ❑
APPLICATION AND STATE THAT THE ABOVE IS COR-
RECT. • PARKING
-
SPACESREQ'D PROVIDED'
' SPACES
SIGNATURE OF
APPLICA FINAL / BY
DATE
ADDRESS
/�� ✓e
• _ Within the scope of this Inspec-
' 7 C tion the Building Official may
approve minor corrections -or
Zlp - alterations of an existing struc-• '
ture involving'work of a-build- pERMI E-E
plumbing, mechanical or
//PHONE
��ry electrical nature. _ ISSUANC EE O
�CD as 6-71.
ITTAL
APPLICATION VALIDATIOU '.•cw' No M.O. CASH .
O • • O
01 • i p
�7 • 00
Co. • O D
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