HomeMy WebLinkAboutX2019-1651 - Permit ApplicationWorksheet far Building Cambo Permit A.ppiicabon �
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NOTF PI AN CHFCK FEE DUE AT TIME OF SUBMITTAL
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Project Address (Nest mailing address) - Floor Suite No
Dascriptiori of Work Use
i # Stories # Units (if
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Valuation _ �,f�t��/�•/�
New/Add SF�� Remodel SF�� I Garage/New/Ad Materiat/L or
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OWNER'S NAME Last � �2��J✓� �i+
Owner's Address
city(/ ---I State Zip one
AF`PLiGAKT'S NAME Last F mt
Applicant's Address Appllcanfs E -mall Address
Glty State �� Zip Telephone
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Lic, No.
ARaHrTECTf6ESIGNER'S NAME: LastEA
Archttect/Deslgner's Address ^. ArchitecUDeslgnet's E-mail Addrese p'
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City %� ����iI State Zip L2"� �°6 4 Telephone
ENGINEER'S NAME Last [ � First �� Llc. No,
Engineers Address Engineer's E-mail Address
City State Zip �� Telephoned J .
CONTRACTOR'S NAMEIGOMPANY (� _ /� /jt � Lic. No. V IassCl
Contractor's Address Contractors E-mail Address -
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L�`(C 2 CC(JMJ FnVi^�uR Ci�' ��b 21Ci� TSS( YJFfLCA>dCsTeJ
CityState _C� ZIP �-(9 (l Telephone
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AERGY P/C FEE $ FIRE P/C FEE $ PERMIT NO.
>RAWNG PIC FEE $ __ PLANNING P/C FEE $
`LECIPLUM/MECH P/C FEE $
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PLAN GHEGK FEE $ I'�