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HomeMy WebLinkAboutX2021-1558 - Permit ApplicationN ►— Comm'I (— Residential V.,Iky ui imcwpulL ucaun - uununiy vlviaiuii r NOTE: PLAN CHECK FEE DUE AT TIME OF SUBIV�f `TPL OM_ 5 (` Building F Grading r Drainage ( Elec F Mech F Plum Cu Yd Cut 0®Cu Yd Fill Project Address (Not mailling address) S� Floor Suite No ILI) _F ®ascription of Work U # StoriT/ry� # Unitsy r Valuation S Material/Labor 4.1, G New/Add SF1 Remodel SF Garage/New/Add i— OWNER'S NAME Last (�f�ST��Y Bf7�� First Owner's Address Owner's E-mail Address City State I— Zip-- Telephone APPLICANT'S NAME Last � (�! �' (•4 First I c Applicant's Address Applicant's E-mail Address City State Zip �'/ 2(� Telephone ^71 c- LlFr�C3 ARCHITECT/DESIGNER'S NAME Last First � Lie. No. Architect/Designees Address Architect/Designer's E-mail Address City I State � Zip [_ Telephoned ENGINEER'S NAME Last First Lie. No.�` Engineer's Address Engineer's E-mail Address City State Zip Telephonef CONTRACTOR'S NAME/COMPANY , p p-It ,. Lie. No.�— Class C- �l V / d�GyI ,_ r Contractor's Address C- _ S' Contractors E-mail Address y� C� �/ 5��i� � � b0�(`6 d P-ODS bC,9 fobs s /%t" / ��� City ` State Zip �Telephone[7/ /v' W�96 �2 I ENERGY P/C FEE $ FIRE P/C FEE S PERMIT NO. GRADING P/C FEE $ PLANNING P/C FEE $ PLAN CHECK NO. ELEC/PLUM/MECH P/C FEE $ PLAN CHECK FEE $ `15g0--,26-2o