15940 SW QUEEN VICTORIA PL AP
! CITY OF _
7.-' 1
1 ttt O NG F,ER iT AP ? CATION T GAR r DATE 19 T�TO
W v:� . 1‘...4
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HERE INDI„ATED
OR AS SHOWN AND APPROVE IN THE ACCOMPANYING PLANS AND SPECIFICATION . OWNER PHONE
/ 2ejz
OWNER - i ADDRESS io?IreS (l 4C, '-/7 U I L D E R PHONE
ENGINEER
P1111.21E! &— ^t ARCHITECT DESIGNER
STRUCTURE ENEW
r--1 D
I REMODEL ADDITION XREPAIR ORENEWAL OFIRE DAMAGE ❑DEMOLITION
'VRESIDENCE 72COMM EDUCATIONAL EGOV'T ERELIGIOUSDPATIO DCAR PORT ❑GARAGE ❑STORAGE OSLAB ❑FENCE
❑BOND MOVING CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
OCCUPANCY LAND USE ZONE BLDG.TYPE FIRE ZONE_ PLAN CHECK BY HEAT .
ezefve4.2---// i /
0-IL 0-74 AP' 4 e' 1.-/ -la", ,4 ' ,
v.- /Lc,/ I
tir2j° '.' if4/2-e-,217&241. .
QCC. LOAD FLOOR LOAD HEIGHT NO. STORIES AREA VALUE /
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit •I .
I? THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
1 PIan Check I REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
1 Recording ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
i ii RESTRICTIVE COVENANTS. CONTRACTOR A'. .13 CONTRACTORS TO HAVE CURRENT CITY BUSINESS
I 1%State I LICENSE. SEPARATE PERMITS REQUIRED FOR ..ER, PLUMBING AND HEATING.
I Tota! ii
( 4,/i P-c-,..4 az.,,de ..______-_
1_F3V-. ,I I AP LICANr u AGES;
Approved , Receipt No.
�. !. _ PHONE
i
ADDRESS
G--CITY-STRUCTURAL. CHANGE.REQUEST
Member /AW4 / Ixt
Date
�
Address /3 40(e� �, :�!��� Phone
TYPE OF CHANGE
(PatioCover, Room, Fence, etc.)
PLAN: DIMENSIONAL AFD MATERIAL DETAILS
_...
(6;
/r127
3 e
Note:
1) Adjacent property owners will be informed of the requested change.
2) If there is an objection, the objection, but not the name of the objector, will
be given to the member asking for the change.
3) The Board of Directors of the Civic Association will review the plans and property
for approval or disapproval and compliance with the stated restrictions.
L ) A building permit must be obtained from the city for all improvements costing over
$500.00
Date Notified KCCA Board of Directors
President
Date to be Completed Approved Vice President
Final Inspection Disallowed (Reasons)