HomeMy Public PortalAbout5321 NOEL DR_Certificate of Occupancy__ 76A662 CE992 4/77
APPLICATION FOR OCCUPANCY INSPECTION
FOR APPLICANT TO FILL IN tor BUILDING
(Print or type only) ADDRESS
4S321 L
BUILDING LOCALITY G
ADDRESS321 lvoj5z OR
CITY �`., _jr ZIP NEAREST O f /v
v VV CROSS ST i.
SIZE OF LOT
NO OF BLDGS u ASSESSOR
O NOW ON LOT y MAP BOOK PAGE PARCEL
DISTRICT TYPE JFIRE SSED BTRACT BLOCK LOT NO CONST OO E t
OWN E Tft3 jr 12t:
USE ZONE MAP
NO �C
ADDRESS
SPECIAL
CONDITIONS
CITY ZIP 1 1
LJ BLDG SET BACK FROM
SIZE OF NO OF FRONT PROP LINE OF (STREET)
EXISTING BLDG STORIES
HIGHWAY + YARD — TOTAL SET BACK FROM TYPE OF Exlsrwc
PRESENT USE OF B ILDIN — FRONT PROP UNE HIGHWAY WIDTH
SET
NO PARKIN-O' SIDE PROPBLINE OFOM (STREET)1 Q
SPACES P VIDED C�
HIGHWAY + YARD— TOTAL SETBACK FROM TYPEOF ExlsrWc C
SIDE PROP UNE HIGHWAY WIDTH
REASON FOR INSPECTION REQUEST + E
d
CORNER CUTOFF YES NO y
Z
OCCUPANCYGROUP
AS VERIFIED OCCUPANT
LOAD
EXIT HARDWARE
PROPOSED MAX OCC NO OF EXITS NO SPEC KNOWL ❑
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS PANIC DEVICES ❑
APPLICATION AND STATE THAT THE ABOVE IS COR
RECT
PARKING REQD� PROVIDED=
SIGNATURE O SPACES
APPLICANT FINAL
DATE O
AODRESSI
Q Within the scope of this Inspec
tion the Building Official may
approve minor corrections or
ZIP alterations of an existing struc
ture Involving work of a build PERMIT FEE
Ing plumbing mechanical or L, 7 PHONE electrical nature ISSUANCE FEE TOTAL FEE
APPLICATION VALIDATION CK M O CASH
5 9 SCID,AUG e-2 2 2 1) 6 10 0 •��