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HomeMy WebLinkAboutX2020-2687 - Permit Application (2)....y .., I --V- uU JUJJ J9 vJVisUn XZ620 NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL wilding Grading Drainage c'�Elec klMech Plum cu Yd nrc! Cu Yd Fill Project Address (Not mailing address) i Flood Fire Liq Landslide N/A Floor Suite No Description of Work -- Us Vit�constType # Stories! s Un its Valuation $ Material/Labor) 7Ct' V New/Add SF, Remodel SF 1 J rj Garage/New/Add i C> OWNER'S NAME Last' _. ._ First; Owners Address Owner's E-mail Address cit ono Y i� State > C„ Zi Tele hone' APPLICANT'S NAME Last i, First Applicants Address Applicant's E-mail Address 3a�� til=r1114- A -T � City 1 ��� r 4—� TIT- States - / f 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 1 1451 lea n-cas�7 r�rl . , t4& City GaS�isti 6� ��i� State 1 e,�O 7_!p Telephone' GCi7 , CONTRACTOR'S NAME/COMPANY Lic. No. Class' Contractor's Address Contractor's E-mail Address City State i zip .. Telephone SETBACKS REAR SETBACKS FRONT PERMIT NO. SETBACKS LEFT SETBACKS RIGHT PLAN CHECK N0. USE ZONE DEVELOPMENT NO PLAN CHECK FEES $