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rBuilding r- Grading
Project Address (A
Description ojf` Work
New/Add SF
OWNER'S NAME
Owner's Address
City �—
APPLICANT'S NAME
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NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
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Remodel SF
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Floor Suite No
Tifstorlesf—
# Units (if Res)[—
Garage/New/Add I —'Valuations I
Material/Labor
Last I `� v First
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Owner's E-mail Address
S�— I � ~
State
Zip) Telephoner�
Last I L�/ �`� �' '
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Applicant's Address First
Applicant's E-mail Address
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City ®/LAw�c� 7 State —
F/ Zip 9Telephone i/� 3�
ARCWITECT/OESI�aNER'S NAME
Last t �'� First
Architect/Designer's Address �`Cs✓ Lic. No. �—
Architect/Designer's E-mail ress
City�I
State — Zip Telephone)-- ---
ENGONEER'SNAME Last i9 — �y
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Engineer's Address � }
_ Engineer's E-mail Address
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CONTRACTOR'S NAME/COMPANY
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Contractor's Address
Contractor's E-mail Address
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Zip C� Telephone[
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ENERGY P/C FEE $ p �����
FIRE P/C FEE S PERMIT No.
GRADING P/C FEE $
PLANNING P/C FEE $ PLAN CHECK N
ELEC/PLUM/MECH P/C FEE $
'1 PLAN CHECK FEE $