HomeMy WebLinkAboutX2020-2312 - Permit ApplicationI rnrn rurm jl VVorIR5111;ai for t eo11113o 61111C11r19 at anular-rermn /%pPlicaYlorl /ll " KB
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Description of Work
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Material/Labor aqu
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OWNER'S NAME Last ��� First
Owner's Address Owner's E-mail Address
City State I — Zip _274, Telephone [ --7 i L( (�'7LF '
APPLICANT'S NAME Last Ll� l� First
Applicant's Address Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last � � e (� (� CV-ek ' First l Lic. No.
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Archhi�tect/Designe�r's'A)ddress ! Architect(Designer's E-mail Address
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ENGINEER'S NAME Last n First r ' C. Lic. Nyo.1.1
Engineer's Address Engineer's
E-mail Address
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CONTRACTOR'S NAME/COMPANY q ��` V 1 Lic. No. FIT, Class
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ity State I ` Zip Cl �fc t( �( Telephone
7e6BACKS REAR SETBACKS FRONT o PERMIT NO.
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SETBACKS LEFT SETBACKS RIGHT 5 PLAN CHECK NO. / V -
USE ZONE - DEVELOPMENT NO PLAN CHECK FEES $