HomeMy WebLinkAboutX2020-1268 - Permit ApplicationPL60,�; 3eCKWoWO(- w/++lwt ON-ro-
L ;h WOrKSheet for Combo Building & Scalar Permit Application � \
F Comm`I Residential Ci o rt Beach - Building Division 44 >
NOTE: PLAN CHECK EES DUE AT TIME
OF SUBMITTAL X W ? tZ Vii a,
Building (- Grading ,Drainage (- Etec
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New/AddSFF� RemodelSFF' Garage/New/Add
OWNER'S NAME Last �
First
Owner's Address
C' &Q 0 R.4 r a'' State FT
AppucA*rs NAME Last —
IN i G. qct' l.- P� to �
M
Floor Suite No
�7 F_
Use ConstType�
# Stories # Units (iP Res)7
Valuation $
Material/Labor
Owner's E-mail Address
Zip "I r Teiephone t', .-I Q I-, - %r. i -,
First I
-- Applicant's E-mail Address
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city Pta u 4 l j l t a state c# _._.
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Zip of f} Telephone 4t -3,36-?,Sio
ARCH IT 'Cr/DFSIG'JEfrS NAME ,`�--
Last c l`rt. s �� ia:9' Jr� ���1 IIc. No. �-
ArchitadlQesignersAddress Architect/Designer's E-mail Address
City State Zip f— TeiephoneF—
ENGINEER'S NAME
Last ON Firsttic Nof�
Engineers .Address ......._ Engineer's E-mail Address
City State k Zip Telephone
F�
CONTRACTOR'S NAME/COMPANY
lrt� L;�. No. q -5101 � cta5srf
Contractor's Address
Contractors E-mail Address
City }, $i t d LS State
(_; Z P ej Telephonel@
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO,
USEZONE DEVELOPMENT NO
KLAN CHECK FEES $ _.