HomeMy WebLinkAboutX2021-2896 - Permit ApplicationF- Comm'I F— Residential "LY "�""P" - v,° . �/ 11 7 �/
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMIT i AL I^ �u L — O <, on<"
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Description of Work
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OWNED'$ NAME Last First
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Owners Address Owner's E-mail Address
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City State Zip 1 Telephoned
APPLICANT'S NAME Last i� r^ 1 -- First c le -11
Applicant's Address Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last First F_ Lia No. F—
Architect/Designers Address Architect/Designers E-mail Address F
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City F— State I Zip �_ TelephoneF— �
ENn7INEWS NAME Last FirstF Lic. No.F_
Engineer's Address Engineer's E-mail Address a
City F— State F_ Zip �`— Telephoned—
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CONTIJACTOR'S NAME/COMPANY Lic. No. i E"2EF2 Class c,_
Contractors Address Contractor's E-mail Address L �'
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GRADING P/C FEE $
a ELEC/PLUMdVIECH P/C FEE $
FIRE P/C FEE S
PLANNING P/C FEE $
PERMIT NO. a �✓� L�—�//� yam},
PLAN CHECK NO.
PLAN CHECK FEE $