HomeMy WebLinkAboutX2018-1300 - Permit ApplicationPrmt Forrri orksheet for Building Combo Permit Application
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Project Address (P
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New/Add SF[ —i Remodel SF r 13, �Q-7 Garage/New/Add
OWNER'S NAME Last I '9a
Owner's Address
First
Owner's E-mail Address
Floor Suite No
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APPLICANT'S NAME Last C--) ruKaki First
Applicant's Address Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last5`i -fl, First P7;; ' — Lic. No. c i u Ko;
ArchitecttDesignees Address Architect/Designees E-mail Address
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City P te` State m Zip L 2;i44 Telephone '7/q Zn ' 5�
CONTRACTOR'S NAME/COMPANY Lic. No. f Class
Contractor's Address Contractor's E-mail Address
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Ci State l eA Zip � � 7CL7 Telephone
ENERGY P/C FEE $
GRADING P/C FEE $
ELEC/PLUM/MECH P/C FEE $
FIRE P/C FEE $
PLANNING P/C FEE $
PERMIT NO.
PLAN CHECK
PLAN CHECK FEE $
DEVELOPMENT # TOTAL FEES PAID $
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APPLICANT'S NAME Last C--) ruKaki First
Applicant's Address Applicant's E-mail Address
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City lLdp State Zipq TO4' .; Telephone5i11L �;Ku ZZZO
ARCHITECT/DESIGNER'S NAME Last5`i -fl, First P7;; ' — Lic. No. c i u Ko;
ArchitecttDesignees Address Architect/Designees E-mail Address
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City P te` State m Zip L 2;i44 Telephone '7/q Zn ' 5�
CONTRACTOR'S NAME/COMPANY Lic. No. f Class
Contractor's Address Contractor's E-mail Address
��/ Gv/�Ztiel�duzr'/w Ott' ;�.ltcGUSi/-c*yr/u
a het -t��` CL/� ---�
Ci State l eA Zip � � 7CL7 Telephone
ENERGY P/C FEE $
GRADING P/C FEE $
ELEC/PLUM/MECH P/C FEE $
FIRE P/C FEE $
PLANNING P/C FEE $
PERMIT NO.
PLAN CHECK
PLAN CHECK FEE $
DEVELOPMENT # TOTAL FEES PAID $