HomeMy WebLinkAboutX2021-2502 - Permit ApplicationI NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL � c
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Project Address (Not mailing address) F Flood F_ Fire F_ Liq F_ Landslide f, NIA Floor Suite No
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Valuation $ pj
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OWNER'S NAME Last ff
P-�dVt9ULL First
Owner's Address
Owner's E-mail Address
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APPLICANT'S NAME Last `{�th�> First
Applicant's Address Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last
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sArchitect/Designer's Address Architect/Designees E-mail Address
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ENGINEER'S NAME Last First Lic. No.�—
Engineer's Address Engineer's E-mail Address
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City State �! Zip �- Telephone
CONTRACTOR'S NAME/COMPANY leu �j r` Lic. No.9_ ; Class
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Contractor's Address Contractor's E-mail Address
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SETBACKS REAR SETBACKS FRONT PERMIT NO. d d r
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK N0
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $ qj D 3