HomeMy WebLinkAboutPV2023-0329 - Permit ApplicationPrint Form Worksheetlding Division
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PCombo BuLAN CHECK ildiES ng B SolUE AT TIME ar FPeerm PermitApplication OWDF Comm'I F Residential
[Building [ Grading ['Drainage [ Elec [ Mech
j- Plum CuvdCut F CuYdFill F
Project Address (Not mailing address) i— Flood
r Fire [ Liq [ Landslide [N/A Floor Suite No
Description of Work
Use F—Const Type F_
# StoriesF # Units (if Res)F_
New/Add SF F_Remodel SFF-Garage/New/Add
Valuation $
Material/Labor / NND
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OWNER'S NAME Last
&bul
First
Owner's Address
Owner's E-mail Address
0A, AZT
City _ State I U-\
Zip FT TelephoneF_ 7
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City '�`4 J
State
Zip Telephone 760- �5 �
1
ARCHITECT/DESIGNER'S NAME
Last First \� Lic. No. �jq
Architect/Designer's Address
Architect/Designer's E-mail Address
City ��5� rytC"�,a
Y
State
Zip �Z(� � Telephone
ENGINEER'S NAME Last
�) �J ICf
First r'.- y ` Lic No.F_
Engineer's Address
Engineer's E-mail Address
T7�
City
State ��
Zip QiZu Telephone 4 ! _ (y'7` _ u'] y
CONTRACTOR'S NAME/COMPANY
Lic. No. F— Class
Contractor's Address
Contractor's E-mail Address
City
State F_
Zip F_ Telephoned
- 2070t 9
SETBACKS REAR
SETBACKS FRONT
PERMIT NO. f 100
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $