HomeMy WebLinkAboutX2018-3276 - Permit ApplicationWorksheet for Combo Bu
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NOTE: PLAN CHECK F
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Description of Work'
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Use Const Type
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APPLICANT'SNAIVIE Lash
First
Appllcant's Address
Ppplicanfs E-mail Address
City
State
Zip
Telephone -
ARCHITECT/DESIGNER'S NAME Last
First
Lic. No.
Arrhitect/Designer'A Address
ArchitecUDesigner's E-mail Address'
City
State
Zipl
- 9 Telephone
ENGINEER'S NAME Last 1:- u �I First F%41E Lic. No! ff_�__
Engineer's Address
Engineer's E-mail Address
City
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CONTRACTOR'S NAME/COMPANY
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Contractor's E-mail Address
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PERMIT NO. --�
PLAN CHECK NO.�
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USEZONE DEVELOPMENT NO
PLAN CHECK FEES $ V2'