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HomeMy WebLinkAbout065-270-002BUTTE COUNTY DEVELOPMENT FEE CERTIFICATION FORM ❑ FEATHER RIVER RECREATION AND PARK DISTRICT (FRRPD) 0 CHICO AREA RECREATION AND PARK DISTRICT (CARD) ©'PARADISE RECREATION AND PARK DISTRICT (PRPD) 0 DURHAM RECREATION AND PARK DISTRICT (DR -PD) Assessor Parcel Number (s)�;%f ?1- ,` 762- Y22 Building Permit Number tl-5- Property Owner (s) Project Location /Address (j 07 Subdivision Name Assessable Sq. Ftge •j Type of Residential Development (check one) _iZ New Development Single Family -Detached Single Family -Attached Alteration/Addition(s) Non -Residential to Residential Multi -Family Dwelling Mobile home Mobile home replacement verified by Assessor Department Demo Permit (date is ued ents: � . ) � verified by Building Department Comm�. G9� . %� /� ❑ FRRPD ❑ CARD B'VRPD ❑ DRPD certifies that: Applicant Mame Phone Number _/moo ►/3 ox 1:12 0 ` I .fir, -dust' Mailing Address City State Zip Has complied with requirements of the Butte County Board of Supervisors Resolution No. by Payment of: Dwelling Units @ $ per unit for a total of $ Square Feet @ per sq foot for a total of $ Remarks: Paid by Check No: Park Paid by Cash: Receipt No: -s 7 -S—D Date ;l BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS 24 HOUR rNSPECTION#:.OROVILL,E: (530) 538-7636 • CHICO: (530) 891-2834 OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OF A PPLICA TION Website: www.buttecounty.net/dds **PLEASE PRINT CLEARL /Y** sl( APPLICANT NAME OWNER Last Name First a Address 1 f3D I city' State State Zips y6 7 Phone 7Z _ Fax 7 E-mail Lic. # APPLICANT NAME CONTRACTOR Name DA )e)1-50 1A Address �r D V0,'IA RcoD City Ko v I r State Flip Phone Q CJ Fax E-mail Planner Lic. # Class APPLICANT NAME ARCHITECT/ENGINEER Name DA )e)1-50 1A Address �r D V0,'IA RcoD City Ko v I r StateC,�_ ZivS-ns-- Phone Q CJ Fax _ 2 E-mail Planner State License Number (o APPLICANT NAME Name X10 Address City State Zip Phone Fax E-mail APP CANT SIGNATURE X For office use only: Zoning roe�y Add C� 5ow�y Flood Zone Cross Street S�- SRA e J No Occ. Type Const. IAJ Subdivision Name Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc L,) PERMIT NO. Gj - X/ACI BIN # LOCATION AP# -0;V-002__ roe�y Add C� 5ow�y City I Cross Street S�- WORKER'S COMPENSATION Policy Number Carrier If hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY Name Address ��`` njs4er Vl Page 1 of 2 Description or47510 pe of Work: 1, Lt)v 6 L 1S36l s ( e Sq. Footage ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the date of application. In order to renew action on an application after expiration, a new application, plans and fee will be REQUEST FOR REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made prior to the expiration of the permit and no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. Received by: 7p, Amount: � �� d3 Bldg SRA Receipt #: ,1/,3UW,3 Sheriff C/0 -,� SMIP Other Date: _��11 / 1 CJS � 64, �r Total REV 2-24-05 1 BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM (One form per Building) Building Department No. - % School Districtell A.P. Number 1/J &S-- Jurisdiction: city Property Owner V A Property Locaon/Address Subdivision Residential Development No of Living Mobile Home Units Installation istrial Now, Addition A A A Lot No. ................ . ... . ... . . .. ......................... ; ............ .................... Sq. Footage Addition/ k *Supplemental to (Group R) Conversion - Permit # *(No foundation Inspection) ........................»_..............................»........ Deed Restricted "Sq. Footage (Attach a signed copy of Deed Restriction and Notice of Limited Use Facility document) Sq- Footage - District ld/en ificaiion No., School District certifies that (Including Exterior Roofed Areas) Date M has complied with the requirements of Resolution No. SqUa-re feet. representing Representative Paid by Check # by payment of $ VB 2926 $ IFULL MMGATION $ 'o'h S— �as- 1 Date Nodc : You may protest the Imposition of the ton klent"Ied above by submMng a wftm protest to the District, In compliance with Qo- wnmwit Code Section 66920(a), wffldn 90 days from the date fen are paid. Failure to submit a timely wrttten protest will'prohlbit .,you from diallanong the Impoettlon of the fen In any court action, K, subsequent to the Sdood District Represented4s signing thb Butte County Schools Impact Fee Certification Form, the School oft.bict is rlstMsd by the applicable Local Planning Agency that this project Is being revi0wed under the Calftimle Environmental Qualfty Act (;EQA), this project may be subject to addMond school foss to fully mitigstaft Impact on the school disb1crs schools. White (applicant), Yellow (building department), Pink (school district) feefonn'.)ds (10/03)dmm BUTTE COUNTY DEVELOPMENT FEE CERTIFICATION FORM 0 FEATHER RIVER RECREATION AND PARK DISTRICT (FRRPD) 0 C1jJCO AREA RECREATION AND PARK DISTRICT (CARD) ARADISE RECREATION AND PARK DISTRICT (PRPD) 0 DURHAM RECREATION AND PARK DISTRICT (DRPD) Assessor Parcel Number (s) l�l�s A '7G?-�x� Building Permit Number 0S�%4.: _I -1 Property Owner (s) Project Location /Address Subdivision Name _1,,"' New Development Alteration/Addition(s) Mobile home Demo Permit (date Comments: Assessable Sq. Ftge Type of Residential Development (check one) Single Family -Detached Non -Residential to Residential Mobile home replacement ped)�� Single Family -Attached Multi -Family Dwelling verified by Assessor Department verified by Building Department 0 FRRPD 0 CARD 0'f RPD ❑ DRPD certifies that: So2o,2Zy y Applicant Rame v Phone Number 02.0 `11S_ Mailing Address City State Zip Has complied with requirements of the Butte County Board of Supervisors Resolution No. OV / l by Payment of. Dwelling Units @ $ per unit for a total of $ 1S3 C7 Square Feet @ $ , yy per sq foot for a total of $ 2 9. Remarks: Paid by Check No: Paid by Cash: KAFORMSWILDTNG FORMS\park-rec standard form rev Ldoc Receipt No: S 7 S—D Date j . S 'j f +JI I I r .i .. a..f 1 . .i - .. w' r. Y ii 7 +F �'. , „ ♦ - :• .y r ... 1 .. ., .. ... .1 �y t ,left• S « f t, : •• . - .. w' r. _ n. L A. _ v. a .. .. �'. , „ ♦ - :• • r ... V ... . .a... .. ., .. ... 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