HomeMy WebLinkAboutX2020-2981 - Permit Application- •rte • uacn - ouuaing Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not Mailing address F Flood II Cu Yd Fill
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Description of Work
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OWNER'S NAME ril_
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Owner's Address Last HAy-ps First
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Owner's E-mail Address
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Zip[ Z(&0 Telephone
APPLICANT'S NAME-
Last -
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Applicant's Address ! First
Applicant's E-mail Address
city
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State LFA Zip
Telephone �105-D
ARCHITECT/DESIGNER'S NAME -
Last f(
Architeot/Designer's Address First tNID
Lic. No.� a'�.'7�{G"�
Architect/Designer's E-mail Address
City Fi'lt%a - C)
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Zip Telephone �__ `C�- r , J, 9
ENGINEER'S NAME
Last
First KA Lic. No. � a ��
Engineer sAddress --
/S7.UI�- Engineer's E-mail Address
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CONTRACTOR'S NAME/COMPANY
Lic. No, s Class—
Contractor's Address
Contractor's E-mail Address
city
State �— Zip Telephones—�
SETBACKS REAR E ACKS FRONT
SETBACKS LEFT --�_ PERMIT NO. ; 7t
SETBACKS RIGHT
USE ZONE m �� PLAN CHECK NO. 1 .�
DEVELOPMENT NO PLAN CHECK FEES $ �I