HomeMy WebLinkAboutF2021-0480 - Permit Application- - - � ILY ui rvCwpui i Dadcn - DuuUln uivision - =
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Please print 3 copies
Associated Building Permit #
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1. Project Address (Not mailing address) Floor Suite No
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Tenant Name �C o& y # Units
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2. Description of Work
Owner's E-mail Address
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Use
City �d9J+
State
Extg Sq Ft �! ko New/Added Sq Ft f -- -Total Sq Ft L)
Valuation$ l' �oo
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Check Appropriate Box for Applicant/Notification
3. Owner's Name Last
16 V) tn tg Co First
Owner's Address
Owner's E-mail Address
City �d9J+
State
ZiP q 417 Telephone "'T 72o -2-37
j- 4. Architec Designer's Name
Last �t First FE -Z-1 a V�k Lic. No. ,
Aarchirytecv si ner'rys—Address
Architecf/Designer's E-mail Address
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City �1 FCA vi C_j
State
Zip F —,1-"fy Telephoned �a
� 5. Engineer's Name Last
First F_ Lic No. �—
Engineer's Address
Engineer's E-mail Address
City �
State I
Zip �� Telephonel_
6. Contractor's Name Last 3
First __vi Lic. No. FSa _-ii i gClass Z
Contractor's Address
Contractor's E-mail Address
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City yzj e Z,- 6a� CA �
State &
Zip Telephone aA t+
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO. f i
OCCUPANCY- GROUP
PLAN CHECK FEE $