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HomeMy WebLinkAboutX2019-4012 - Permit Applicationk .... r, X,2041t U Worksheet for Combo Building' filar Permit Application g Division V E,OF SUBMITTAL Owner's Atltlress Owner's E-mallAddress, 2p 1J 0 City e 03 ,., , .. :State.. Zip : fele hohe P ARRLIC/�NT'S NAM Last First Applicant's„Address, 'Applicant'sE-mai?,d ress” tM C. b {� Gll.l�laer"y3(Djx,`tiva Ca , City R: ; State Zip ; ', Telephone� t!Cj ARCHITECT;/DE51GNEtt'S,.NAMEZ. o Last First.. Lic. No. ArchitecNDesigner's Address ArchitectlDeSigner's;E-mail Adtlress '; City L StateZip 0$ Telephone M "KU77� z a ENGINEER'SNAME Last First Lic. No.E,:!,�. 'Engineer's Address Engineer's EmaitAddress ' City State zip�Telephone CONTRACTOR'S NAME/COMPANY Lic. No. Class Contractors Address Contractor's E-mail Address ;- ty ..,,. .. State. SETBACKS REAR - ' SETBACKS FRONT. PERMIT NO. XZO r — y-a'.c SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.— . USE ZONE '. DEVELOPMENT NO - PLAN CHECK FEES $