HomeMy WebLinkAboutX2015-2624 - Permit Application (3),y .... ... Nl . ,.. weu wi("V.� �u ra rin
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riro�fit AddiFesyys (NO$ Inraana11uwg 21ddvegs) Flood C Fire [ Liq --- Landslide -_ N/A Floor Suite No
Desceiption of Work Use g/Ct Type I 7e
l�E�O oy ,P:X/5,7 PL)a hl�h/ Cous
# Stories # Units (if Res)[
Va nation $ ud
New/Add SF Remodel SFF_Garage/New/Add Ef/ Material/Labor �1dOD/090,
OWNER'S NAME Last �ELG/�j4 First JD f%a1
Owner's Address
Owners E-mail Address
— --- — —
City ffycyf/P0,27 j�r*j/ — State �} Zip Telephone 03 3O 5
72%
APPLICANT'S NAME Last �lil�jJf7/y/ i First
Applicant's Address Applicant's E-mail Address
�I747,_
City State �i�_! Zip 9ZlOS/i Telephone�7w
ARCHITECT/DESIGNER'S NAME Last( �`Ol�j7 First
`� f _...__.._ ---- Lic No.
Architect/Designer's Address Architect/Designer's E-mail Address
3/7¢2 4� -644s7 /-IpVY
- - -- ----
City l-A60A-/A O'�Y'16 -% State Zip Telephone
ENGINEER'S NAME Last [—,js6F First r/ Lic No
— — — -- ---- — (1/
E/ngineer's Address Engineer's E-mail Address
City---/ll��E ...__..._. State -_�j� ..j Zip /�/L10� : Telephone .-
_ 49 X97 tv8ra
CONTRACTOR'S NAME/COMPANY �/ CliMP`� Lic No g0/e/4- Class ,
Contractor's Address Contractor's E-mail Address
332�Es7 ASE
---- — - - ------
City 4,45�aAIA 8�AL-_d -- State Zip 9Z10t�rl ,....Telephone �
SETBACKS REAR (p F�- SETBACKS FRONT PERMIT NO.
SETBACKS LEFT tD F7. SETBACKS RIGHT PLAN CHECK NO.
JSE ZONE,Q 4i—/ R—/ 641ZEVELOPMENT NO PLAN CHECK FEES $
/A�3-,2015