HomeMy WebLinkAboutRS042141_application formkrC0yZ1y1
COUNTY OF ORANGEIPLANNING AND DEVELOPMENT SERVICES
APPLICANT'S INFORMATION SHEET FOR A BUILDINGIGRADING PERMIT
Applicant must legibly PRINT in all of the known indicated information. PERMIT NUMBER:
BUILDING ADDRESS OF PROJECT I=-% �cd-r/ ?,r✓f,��/•�� �`�/�
G
LEGAL DESCRIPTION OF PROJECT SITE; Number TomStreet eneral Area
(if metes & bounds then you must provide a recorded copy of the Grant Deed.) ract Block Lot
ASS"ESSOR'S PARCEL (AP) NO. "hD
ZONE:
NEAREST CROSS STREETS:
OWNER/BUSINESS NAME:
OWNER'S PRESENT ADDRESS:
General Area of CountylCity
SPECIAL PERMIT NUMBER:
Number
Use PermiVSHe PianNarience
Zip
Street
Phone Ne.
PROPOSED USE OF STRUCTURE. This must be clearly spelled out in detail as to exactly what is the intended
use, The terms "OFFICE" or "COMMERCIAL BUILDING" are NOT sufficient to determine if the proposed use
meets the Zoning District Regulations, Occupancy Group, or if the TYPE OF CONSTRUCTEON Witt permit the
proposed use. BE SPECIFIC:
STRUCTURE SIZE SQUARE FEET, f Tw
Total IstFloor 2nd Floor 3rd floor
GARAGE SIZE SQUARE FEET: SIZE SQUARE FEET
(other)
CONTRACTOR: f
Name License Number Classification ,
Number Street
N0skers Gump Carrier
Area/C ity
Phone No.
Rate of Expiration
ARGhiITECT: l
Name Lic. No. Number Street Area/City Phone No.
ENGINEER:
Policy Number
Name Lic- No. Number Sueet Area/City Phone 140.
CONTACT PERSON: 4;l e,ffi b _r�. AFFiLIATIGN:�
FAQ. # ^i-°i �S�L_•fi�= s_ PHONE # `� 5-�• c f —E-MA-IL•
APPLICABLE TO GRADING ONLY
SOIL ENGR:
ENGR, GEOL:
Name Lis. No. Number Street Area/City Phone No.
�
Name Lic. No, Number Street ArealCity Phone No.
GAUOSHA REQUIREMENTSICHECK APPLICABLE BOX: ❑ I am the owner -builder and exempt from state
permit requirements/0 I acknowledge that I must submit proof of issuance of CAUOSHA permit for the proyecV
❑ The project does not require a CAL/OSHA permit, based upon the criteria on the reverse side of this sheet.
hereby certify that to the best of m -k wledge the information supplied on this information sheet is true and cacrect.
GNATURE ._ .. ---- , `ATr
�i
Pro
or Authorized Agent
SEL'OTHER SiDE 7N