Euclid E 15000 Kaiser Office & MTL Addn
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BUILDING PERMIT APPLiCATI'OIV WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS 4F THE FORM YOD UNDERSTAND
(Please return this origlnal and yaur building plane to the Department of Build(ng and Safety)
, ownerls Name, - c~~, m~st~ (m) oe~tir~em uee only
~ ~ o 9:2mqr'O Fbs Comm ~
2 ProleGt Addreos (not,Maillqg Address) or Road Name 8Aace ziP
rO . %soao 1*uc.L.%0 av
3 CitylCotunut►Ity 818te Subd(vletOn/PiBt Nert1e
9F~~~~ ~y~,ar,.
a Asaeesor Paros! Nhro Lot ' 9tak
11~ 4~ O~i f► DEPAIiTMENTU8EONLY
5 sic OoQe Zone Act i Zane Prolect No ~
8 Owell A No oi 8ulldings 8q Ft /Aere Dep1h "twe
~ i7 Set BedaFront (L)8.1 (p)S,? Rear CansuslTract Module No Inlttets
• 18 Anhlted Flrm Name ajc~ ~Addrm
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Omteu1~',/Ipqsm "'s~~~ MAPRU ~ Phoae ff dlfferent tl~n BbWe dkrp
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~ CmVectorFlrm Name fMreet Mdrea
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Ziv aty s~e w~e
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Cantact POson Uoense No P~hoRe If dtlterent than ~b~ve
&Oifig: `
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8,OwnerlAgmt (fi ditterent ihan fl2bm) ~ Buel~sa Addresa
- ~ I 9 Zip Gty 8t8te ,Phmee
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12 Revlew Requlred Ptan CAeolt `(YIN) Qther (Y!N) SEPA Exempt,(Y!N) Qate
~s Vrs NO
15 Type Work 8tdg 10 MH Q New D Replaae p' Other
O Flre p Demo ~Add/plte► D ~Move
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14 o~oewanc I $~toG M&--O u #*4WL
&k%:0 4
10 Appticent NBmB`~ 8ireet Addresa
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i 11 Zip Gty 8Phone -
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* ' - le+det - - SKset A0dres8 ~ e
~ Dp City 3tate Phone
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Contaat Petson Phane tf dlHerent thsn abrnre
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Addl t ional Intannatlan
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I - - - - _ - _
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DEPARTMEtdT APPROVAL-S
This is not a Permit
Applk.ation Type
(Standard unless (Indicated epprovels requlred ineither`•release" or "releaee with condltlona'
otRerwise Indiceted) space prlor to permll issuame ) FaBt Track
~ Ea~'ly Stsrt Relesse
Release w/cond 1 Hold 2
f
Environmentel Heetth 14' Commerclal. O Resldentlal
W 1101 College p New Constructlon, O 61dg alteratlonladdltion
, Room 200 ❑ Addltional atructure,
APPLICATION f!
Condittona/Comments
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Plenning/Zonlne: 4eCommerclal, ~ Cert ot Exemption; ❑ Frontege,
N 721 Jefferson Cl Setbacics, O lot wld, O Iot elze, ❑ use/zone,
O CU. varlance, zone change, shorelirts, ' 13 fenae,
O Other -
Conditians/Comments -
/
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Englneero• . 0 Resldentlal, O Ftood Plaln,
VCommorcial,
N 811 JeNerson 10, drainage O nsw access/approach, 13` fenoe, -
01 road improvements
Condltlons/Comments ~ • - ~
0 UtlUtlas:
N 811 JeNereon ,
_Candltione/Comments
❑
Otlrer. - -
_ I
Pinn Exain
Flr`e Prev.
Condltlone/Commente
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N -
_
~ ProJect Aepreeentative - Telephone
~n Agertcies Periorm(ne Special Inspectlon
~ c y
Y O -
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! Inakete above o► attwh condltlona rolelhre to final ea built approval
! 2 Indkafe ebonre or aftsch reasons lor hold
t't~.►,~. ~ ~ ~ - ~ - - - ' Ni~t,n~- - -
j Z- k!'_~~ Piluue No. 456-~b~lt1
l~,~uit iet I1.oll
.
t~ C:t)MU11.ttC IAL til t I t.i)I hI, NElN1 L'l Ith.V 1EW
!'iii b tatli 1RI1~~g pecini t review is Intesitied tu tppraise you uf the impruvementt, ( roaciway, si.ie-
walk, r«rb, st~jcn►wa[cr, dtL.) wltich must h4• cuiiotructed in associa[tnn with yuur builJing
permit. fhls eiieckltst will krt- filled mit I►y ttir Engineer's staff and a cppy will be re-
tucneJ Lu ynu at the time th.it ttic: permit is iiiitialed by the Engineering Department. All
reyuiretnents bhall be ccimpleted prtor tu IsSUance of the building permi[. All unchecked
buxrs require additional rtsearch ur infurma[ton to make a determination.
1. Starmwater Drainage Considerations
A. Per gufdeMnes zor "Stocmwater Mdiiagement 1981" both on and off site.
1. 208 Conyiderations* ~ Yes Li Nn
2. F'lood ha za rd zone cone~i dera t i c~ns** ~ Yes ~ No
3. Stornu Drainage Plan ~ Yes Li No
II. plannino Action # ~
1. Rezdne. Conditional Use or Variance on property ~ Yes Li No
2. Are requirements of planning action incorporated ~ Yes p No
into site plan
t I I. Righr of Way
1. Does permit necessitate R.O.W. dedicatioa ~ Yes No
2. Did zone change require R.O.W. dedication ~ Yes ~ No
3. Radiua at corner a Yes ~ No
IV. County Road Improvements
1. Roada need to be improved. Now wide a Yes No
2. Curb ~ Yes No
3. CItP/RID agreement (Copy of deed, contract, or ~ Yes No
title report required.) ~
4. Plans for improvements provided Yes No
5. Sidewalk ~ Yes NO
V. Partcing Plan 6 AQproach Location
1. Review and sign off by Traffic a Yes No
20 Approach Permit from Engineer's Office ~ Yes No
3. State or City sign off ~ Yes Nu
40 Is this road on 6 Year Plan a Yes No
V 1. ULI U Agreement : L,..I Yes NQ
VCI. Eield Review: Preliminary Cummeiits