HomeMy WebLinkAbout027-070-015I I
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LTNEKER, W.E.
997-70B
6,625 Citrus Ave., P ermo .
-iPartial reroof)
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FIRE DAMAGE REPORT
DATE:
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TO 'Building Department
FROM:,f Environmental Health ,
SUBJECT: Sanitation Clearance
owner-/ Location AP#
Plan Approved for: Sewage Disposal.', ;Water Supply�..
Hold final-for: Water,Supply
Final clearance O.K. for: Water Supply
. Clearance.for 3 bedroom mobile ome. Other
NOTE
Sanitarian -
Date
1
FIR DAMAGE REPORT
OWNER:
LOCATION: &Z S
CONTRACTOR:
DATE TO INSPECTOR: _ 13 —OS PERMrr HISTORY:( ) NONE
DATE-
A.P.
S - 2 —O S
#.O Z-7-070 -O S S
ZONING:.
O AS FOLLOWS: �' G
BUILDING INSPECTOR'S REPORT
Building Description:
Commercial/Usage:
Residential/# of Units:
Currently Occupied
Abandoned/Vacant-
Electric:
Yes No Electric currently On Off
Condition of Electric
Gas:
Natural Propane None Currently On Off "
Obvious Problems:
Sanitation:
Plumbing Working
Well Working Potable Water
Obvious SewageProblems
Description of Damaged Area:
Estimate Valuation of Damaged Area:
Condition of Foundation:
Mobile Home: Condition of Utilities: -
Inspector. Date
Sketch building on reverse and indicate area of damage: ,
CDF4BUHE f
gQUNjj FIRE INQDENI
INCIDENT NUMBER 4639
DATE 5/2/2005 EVENT NUMBE I 4669 LOGGED B MB
REPORT TIME 11:031 LOCAL FIRE NUMBE I J Caaf i r+�arF re RO DAMON
STATE FIRE NUMBER 132 +A�r ¢lata Firn n-s-f-ro-- BI
CASE NUMBERi ax�ranelt,<' MEDICS
........... ... _........_
LOCATION 16625 CITRUS AVE • PRA 111 ECC ❑
... _......-- .---............
RP TRISH PHONE NUMBER 533-8952 REPORT METHO 911
WILDLAND FIRES ❑ ESTIMATED ACRES 111 01 .............._...................
. FIRE INFORMATION
_.............................._........_........._........._._..a..................,_.
STRUCTURE FIRE RESIDENTIAL FIRE INFO SENT HO •EMAIL BY MB TO STA 72
OTHER FIRE �� 7 -DAY LOGGED INITIALS TB
MEDICAL AIDS INCIDENT NAM• CITRUS
PSA/OTHER �._� START DATE 5/ 2/2005. START TIME 11.00
HAZ MATDIAMOND # 1.1-1.8
.
Billable Incident ❑ CAUSE IF
LECTRICAL POWER
COMMENTS LAND USE DOMESTIC
EXT
ACRES , TYPE OF ACRE
;STRUCT
DIAMOND 5 ONLY $ DAMAGE TYPE:
a _
i
DOLLAR DAMAGEir
1000.00 SAVE -25000.00
INJURIES/FATALITIES ❑
# CIVILIAN INJURIES '# CIVILIAN FATALITIES
EMD ❑ OES ❑
# FF INJURIE 0 # FF FATALITIES
FC -40 INFORMATION
4' New.lncidenE - �.
i� { FC -40 ❑ DATE OF FC -40 INC
AGENCY INC # INC P#
FCO COMP DATE# FC -40 COMP BY
...._—
County Notifications 0 EARS Hard Copy Recieved ❑ EARS Checked Agenst EARS Computer ❑
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