HomeMy WebLinkAboutM2021-0045 - Permit ApplicationF Comm'I tesidential u¢y or roewport tseacn - isuuaing Uivision $ ' ,_ _ ¢
1 NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL E��� cu.oa
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Project Address (Not mailing address) Flood (- Firer Liq f- Landslide rN/A Floor Suite No
Description of Work ® Use Const Type
" f # StoriesF # Units (if Res)71,
Valuation $
New/Add SF Remodel SF�—, Garage/N Add Material/Labor
OWNER'S NAME
Last First
Owner's Address Owner's E-mail Address
City - ✓ - State ZipTalepho e
APPLICANT'S NAM LastLLL���. t -
i First �
Applicant's Address Applicant's E-mail Address
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City State I-23F Zip / Telephone
ARCHITECT/DESIGNER'S NAME Last �— First b `t Lic. `No.�wYf"0 C
Architect/Designees Address Architect/Designer's E-mail Address
cityli �j dlV1�1 ` L'� State I (r' J� ZipTelephone ��rr
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ENGINEER'S NAME Last Fustf�wavLic. No. e,l�c�
Engineer's Address Engineer's E-mail Address
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City %v ►C -.- " ( State Zipt �� f� Telephone
CONTRACTOR'S NAME/COMPANY CUv�c , e` Lic. No. Class
Contractor's Address Contractor's E-mail Address
City l Y l n u State Zip -z- Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO. )11 EJvL:-4 • �5
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. 1:U S C �
USE ZONE DEVELOPMENT NO "�iJ9 • PLAN CHECK FEES $