HomeMy WebLinkAboutX2020-2687 - Permit Application (2)....y .., I --V- uU JUJJ J9 vJVisUn XZ620
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) i Flood Fire Liq Landslide N/A Floor Suite No
Description of Work
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Valuation $
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OWNER'S NAME Last'
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Owners Address
Owner's E-mail Address
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APPLICANT'S NAME Last i,
First
Applicants Address
Applicant's E-mail Address
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Zip �f�� Telephone;
ARCHITECT/DESIGNER'S NAME
Last 1First
Lic. No.�
Architect/Designers Address
ArchitecUDes!gners E-mail Address
City I State —
Zi I Telephone
ENGINEER'S NAME Last, LA1. �5ctQ
First r Pig Lic. No,
Engineers Address
Engineer's E-mail Address
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City GaS�isti 6� ��i� State 1 e,�O
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CONTRACTOR'S NAME/COMPANY
Lic. No. Class'
Contractor's Address
Contractor's E-mail Address
City State
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zip .. Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK N0.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $