HomeMy WebLinkAboutX2021-3042 - Permit Application�^ rota uut AT TIME OF SUBMITTALw r vv rB
s
uilding Grading Draina e rElec Mech['PIUm
Cu Yd Cut F7
Cu Yd Fill
Project Address (Not mailing address) [ Flood j- Fire j- Liq
Landslide F Floor
� 30 L Suite No
- --- — -- � `L 'E� R;., � L ;tip � -��
Description of Work - 1� - ctV1 U;Z� Y}c JA 2
(�1#ct�2�L4� L.tc3E �u5 -r Ss1uC= Use F Const Type
n
- — # Stories # Units (if Res)
New/Add SF�- Remodel SF -- --
r{ O Garage/New/Add �— Valuation $
r:
OWNER'S NAME III
Last Material/Labo
(���'--2 L --- _ - --
1 t-
Owner's Address First
Owner's E-mail Address
City
- State
— Zip Telephone
APPLICANTS NAME — -
Last ---
_
Applicant's Address kylAAFirst ��"-
--
Applicant's E-mail Address
_�--d>
cityz , -
��_v_ e—_ -- - State
Zip _ `�� Telephone
ARCHITECT/DESIGNER'S NAME ----
Last
First
Architect/Designer's Address -- _ Lic. No.
Architect/Designer's E-mail Address
City -State Zip -- -
-- Telephoner—
ENGINEERS
elephoner
ENGINEER'S NAME Last
- _ First
Engineer's Address LIC. No.�--
Engineer's E-mail Address
City' -
State Zip—
_ Telephone�-- ,
CONTRACTOR'S NAME/COMPANY e i j
ny., .[\In;;It'G.' c �� Lic. No. //_ 74/.,r': Class
Contractor's Address Icr 1�
L I,S ' Contractor's E-mail Address
City 11 rc iuYL ra�Ct�t!
State $fY�CfIGLr�i'�e,I4f I • e�:-a„
,id ,Yle q - - l
Zip �1a�Lt Telephone C.
X17-: 6;6. 2-
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT -�_ PERMIT NO.
SETBACKS RIGHT
USE ZONE PLAN CHECK N0. --
DEVELOPMENT NO PLAN CHECK FEES $ —_