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HomeMy WebLinkAboutX2017-3537 - Permit ApplicationQ.tt?✓tdan+,. :City State Zip Telephoned SETBACKS REAR SETBACKS FRONT PERMIT NO, SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. zo66 -Zo17 Project Address (Not malliffiji 1 dress) (� Flood > Fire uq Landslide I -aiH Floor SwteyNo ria f ,3 .I ' ,/� S t A -. Description of,Work R ^ q a , 'F° C i�. : J ir` n �+ Us e 4 y a 4 w i - 0 Const TypeFV f Stiness` 7t'ln s (if Res)s ))1CC\i5. At New/AddSF RemodelSF, e'eAdd r }7' 'Ntatenal/ia�bo�r'µ OWNER'S NAI i `' - /7 i 7 Firstt Owner's Address Owners E-mail Address 19: 0100 `City '. State ..Zip F Telephone— APPLICANT 5 NAME Last " First = , ,,Apphc nts:Address �, Applicants E mail,Address '-. Ce Zip Telephone I ' ARCHITECTlDESIGNER S NAMES Last n w �/ �fia�� Lic: No. �l �'(�- � First �G (� �` Architect/Designer's Address Architect/Designer's E-ma'il Address -0 C .City '�`'p,�, / �',p State U��11D1" 4i - Zip �- Telephone' ENGINEER'S NAME Last n,�j S, First Lic. No. rum Engineer's Address Engineer's E-mail Address I FPO City F, State Zip F Telephone ` lyOi �tri751 CONTRACTOR'S NAME/COMPANY E _ s� r ��tpn Lic. No; 8 W Class Contra es Address Contractor's E-mail Address Q.tt?✓tdan+,. :City State Zip Telephoned SETBACKS REAR SETBACKS FRONT PERMIT NO, SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. zo66 -Zo17