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HomeMy Public PortalAbout5841 ROWLAND AVE_Certificate of Occupancy__ 7GA662-CE992-4/77 , .APPLICATION FOR OCCUPANCY INSPECTION FOR APPLICANT TO FILL IN BUILDING (Print or type only) ADDRESS y BUILDING 4'. LOCALITY ADDRESS CITY` -IC ZIP /ti NEAREST 29 v 'CROSS ST. SIZE OF LOT NO.OF B DGS. ASSESSOR NOW ON LOT MAP BOOK PAGE PARCEL DISTRICT TYPEFIRE SED BY TRACT BLOCK LOT NO. /a CONST. ZNE OWNE EL © NO. USE:�1� NO.E MAP vCJ � ADDRESStm K. COND TIONS CIT ZIP Q BLDG.SET BACK FROM' SIZE OF ^ NO.OF FRONT PROP.LINE OF (STREET) EXISTING BLDG. I(J STORIES HIGHWAY + YARD= TOTAL SET BACK FROM 'TYPEINIG PRESENT USE OF BUILDING FRONT PROP.UNE HIGHWAY WY WIDD TH BLDG.SET BACK FROM NO.PARKINGSIDE PROP.LINE OF (STREET)) C SPACES PROVIDED O TOTAL SETBACK FROM TYPE OF MEWING HIGHWAY + YARD= SIDE PROP. LINE HIGHWAY WIDTH C F REASON FOR INSPECTION REQUEST + — 4 • n Q n CORNER CUTOFF YES NO u !i a q OCCUPANCY GROUP AS VERIFIED OCCUPANT LOAD EXIT HARDWARE: PROPOSED MAX.OCC. NO SPEC. KNOWL. ❑ NO.OF EXITS 1 HEREBY ACKNOWLEDG AT I HAVE AD THIS PANIC DEVICES ElAPPLICATI STAT HAT HEA E IS COR- RECT. PARKING: REQ'D PROVIDED SPACES SIGNATU OF APPLICAN INfiL� .9t- BY i �%Amhfr ATE I ADDRESS /,� /"a /Se -7 i a7 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 PHONE electrical nature. ISSUANC' TOTAL FEE �rfv(IJ pt® / APPLICATION VALIDATION CK. M.O. CASH 5 5 7-AUG 10 4 A ' .0 0