HomeMy WebLinkAboutX2021-0595 - Permit Application (2)ucai� r�
Prinf Form Worksheet for Combo Building fang & So9acrvP Permit pP G4FOP„"=
City of
r, Comm I j�zi Residential NOTE- PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
u Yd Pill I 1 (jJ•
C III
Drainage (X Elec (X Mech r Plum Cu vd cut 135 Suite No
r,Building r Grading [ Landslide I N/A Floor
address) r Flood r Fire r Liq f
aroiect Address (Not mailingI
Dorchester
of Work
New/Add 5F3415
Remodel SF�-�
Garage/New/Add 751
APPLICANTS NAME Last 11 eale
ARCHITECT/DESIGNER'S NAME Last
Architect/Designees Address
see above
State
city _ _
ENGINEER'S NAME
Last Israel
Use R-3/U ConstType F
prk'i
# StoriesF # Units (if Res)r 1
FirstJMichael & Diane
Applicant's E-mail Address
mteale@tealearchitecture.com
Telephone 49-975-0123
zip �92E6
-
First Mark Lic. No. C-22162
........ ........ .......
E ail Adores —
Architect/Designers-m______�
Zip — TelephoneI
Lic. No.C77167
First Michael - - ' '
Engineer's E-mail Address
Engineer's Address mike@coastlineenginc.com - -- -
5927 Balfour Ct
Zip 92008
State CA
City Carlsbad Telephone 760-436-1344 Class 7
-- Lic. No. F-,
CONTRACTOR'S NAME/COMPANY - Contractor's E-mail Address
Contractor's Address _.
IState F` Zip Telephone....-
City ..........
SETBACKS FRONT
PERMIT NO.
CK NO c
SETBACKS REAR —_ PLAN CHE
SETBACKS RIGHT
SETBACKS LEFT _ J1? 'C �� PLAN CHECK FEES $
USE ZONE DEVELOPMENT NO 1 i