HomeMy WebLinkAboutX2021-0065 - Permit ApplicationF- Comm'I Residential c ny or ivewpon rseacn - ouuaing uivision X Z X21 04 dj 5
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL <o,a"
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Project Address (Not mailing address) r Flood r Fire 1- Liq r Landslide rN/A Floor Suite No
Description of Work
Use PEL Const Type
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Valuation
New/Add SF 74;_k Remodel SF WON T- Garage/New/Add
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Material/Labor 4 i4ziro O
OWNER'S NAME Last U IJ, First I rJ A-V 140
Owner's Address Owner's E-mail Address
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City PCO'L �OV-q' State p Zip ;IeZ( (,0Telephone I-i�"1;-U61._"2/4 1-7
APPLICANT'S NAME Last Akjc2*_1U_ First I F2, t
Applicant's Address Applicant's E-mail Address
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City I Y r)1 .4) 1,0d.> V L p State —', Zip Z7 Tefephone q 4CI 6, I�
ARCHITECT/DESIGNER'S
--�NAMEas zr- Li FirstLic. No.,„1c
Architect/Designer's Address Architect/Designer's E-mail Address
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City I rn ) yra, i9 19E �O State I E- Zip l '641 TelephoneFq C; sz q- CE; -111
ENGINEER'S NAME Last L 1 ovl •• C ��1 FirstE) Y\l LA, Lic. No.C_, %I ,,Z 19
Engineer's Address Engineer's E-mail Address
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City 14� � State (� Zip 2%G%d Telephone `3 Icy G, 17 9 C)
CONTRACTOR'S NAME/COMPANY 'ply A, Lic. No. Class
Contractor's Address Contractor's E-mail Addrrejss
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ACKS REAR (� I SETBACKS FRONT rt 11)" PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NC_ Uo
USE ZONE Q HIle(mor k4JDEVELOPMENT NO Z(Jb(PLAN CHECK FEES $ 4J/o'I y