HomeMy WebLinkAboutX2013-0401 - Permit ApplicationBE— w or -`" Worksheet for Building Combo Permit Application
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Description
Description of Work
Use
RIESfPENOE To eHE7 bum_ ON
# Stones # Units (if Resf :
FM PTY
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Valuation $
Material/Labor
New/Add SF ((p %�(7 Remodel SF�� Garage e /Add ��q?0
OWNER'S NAME Last -7 First Pt"'I'11-
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Owners Address Owner's E-mail Address
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City -lfd .�-r State Zip�Zin.(•nU- TelephoneF
APPLICANT'S NAME Last t IS{11't L First
Applicant's Address Applicant's E-mail Address
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City -._J 7 - _ _ J State CS'I _-! Zip q�(p� U I TelephoneN e5�
ARCHITECT/DESIGNER'S NAME Last 2z1
L�c7�(1 First ✓H�IST�i Lic.No.I �z
Architect/Designer's Address Architect/Designer's E-mail Address
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City -N ---..— Telephone
ZIP q n6U1d�'39
ENGINEER'S NAME Last i2C� � �� - First N '-�
Lic. No y87
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Engineer's Address Engineer's E-mail Address
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city State -- 1I I 1 • P—
y _V -! - -- State C� — Zip _--. ..-- - -- Tele hone /S -0'775.
CONTRACTOR'SNAME/COMPANY / — Lic. No.[� Class
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Contractor's Address Contractor,'s, E-mail Address
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City --- -�� State Zip"ET "i Zh I - �� Telephone .,r�[(H1(S
ENERGY P/C FEE $ ZC.Q�Q•D� FIRE P/C FEE $ , �,; II1 ;, �PErF fy11T NO. SPI -j • 6_(491
GRADING P/C FEE $ PLANNING /P,(/)FEE $ PLAN CHECK NO. 1-0/3
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ELEC/PLUM/MECH P/C FEE $ _ l(i 3S'�� `Y• PLAN CHECK FEE $®
DEVELOPMENT # _ (-t TOTAL FEES PAID $