Sprague E 10708 Budget Oil - Zip Trip
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(THIS IS IdOTA PERMIT)
BUILDING PERMIT APPLICATION VIiOAKSHEET
PLEASE PRI NT AND COMPLETE ONI.Y THOSE PARTS OF THE FORM YOD UNOERSTAND
COMPLETE IN INK
(Pisase return thts orlginal and your bullding ptene to the Oepartment,of 9ullding end Satety)
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Owner' LABT FIRST MI
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Addltfanal InformatFon
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8utlding Technlcian (iroup ~ Type
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DEPARYMENTAL REVIEW
Approved qpproal Hold
, Environmental Health Applicatlon # 0" I +
~ W 1101 College
Raom 200
~ • l ~ 1 ~ *
4d " Planning/Zoning
N 721 Jefferson
~ 6-
~ Engineers
N 811 Jetferson
uuuu~s
❑ N 811 JsNerson
Plsn iiev[sw/ Fire PrevenUon
❑ N 811 Jefferson
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Other (BEPA/Crltkal Meterial/et~.)
❑
❑ ~ Feat TrecliclSpsclel tnspeot[on InbrmaUon
ProJect Representatlve Phone
Address
I certlty that I have examined this appltcatton e►nd state that the Informatlon, contained 1n it and submitted
by me or my agent fo`comp(le said applicatlon Is true end correct
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Stpneture _ Date
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t c Verbuai Namr ''k ~ Bueineas Name ~ Ll)
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1.1.11 L55 } f AddCNSS t- / O7e. $ >Oe2
111i4„li, Phone - - -
c.011111v C0iItdc.t Phone No. 456-36UU
CUMMEltCIAL BUILDIN6 PERMIT 1tEVIEW •
I tii , t~id 1ding permit review is intended to appraise you of the improvementb ( cuadwdy, 51 t~ -
wi11., curh, bCurmwater, etc. ) which muet be constcucted in association witti your bui l.i~ ~ig
lit, i it L t. Titiri ctiecklist will be filled out by the Engineer'e etaff and a copy will br rt.-
Ltic-rieJ tu yau it the time that the permit is initialed by the Ergineering iepartmrnt. All
~~~lui re«ietlt5 sIial t be completed prior to issuance of the building permit. All uncllecked
h~~Neb requicr dJditiunal rebearch or information to make a de[ennination.
1. Starmwater Ucaina e Gnnsiderations
A. Per Ktifd-eMnes tor "Stormwater Management 1981" both on and off eite.
l. 208 Considecations* 14 Yes ~ 140
2. Flood ha2acd zone consideratione** Li Yes ~ Nu
3. Stucm Drainage Plan tg. Yes ~ No
,ow-f I I. Planning Action #
Rezone, Conditional Uae or Variance oa property Li Yes ~ Nu
2. Are requirementa of planning action incorporeted Li Yes a Nu
i nto si te plan
111. !jght of Way
1. Does permit neceasita[e R.O.W. dedicatioa ti Yes ~ No
2. Did zone change require R.O.W. dedicetion ti Yes ~ No
3. Radius at cornec Li Yes ~ Nu
1V. County Road Improvemente
1. Roads need to be improved. Hov wide ti Yes ~ Nu
2. Curb ti Yes ~ Nu
3. CRP/RID agreement (Copy of deed. contcact, or p Yes Nu
title repoct required.)
4. Plans for improvements provided Yes No
S. Sidewalk Yes ~ N~
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V. 1~arkin& Plan 6 Approach Location
1. Review and sign off by 1YafFic ~ Yes ~ No
2. Appruach pe rmit f com Engineer' 8 Of f ice Yes h'
3. State or City sign off ~ Yes ~ h•~
4. Ts rhis ruad on 6 Year Plan a Yes .
.1. 1,1 f I, Acret•men[ : ~ Yes 11 kt-vf ew. i'r` 1 Lmi n,,ry Corrtmente
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