HomeMy WebLinkAboutF2021-0527 - Permit Application0
Associated Building Permit #
[ Fire Sprinkler Ei Fire Alarm
[I Fire Misc
1. Project Addres (Not mailing address)
Floor
Suite
Tenant Name
#Units
2 Description of Work r
Ll - -- tea. _.�..�q„�'°�✓ H'
,...- ...._Use
Extg Sq Ft New/Added Sq Ft Total Sq Ft Valuation $ 0- J
_L:6ew [ Add [ Alter(---
[ Demo #Stories
I y i
Check Appropriate Box for Applicant/Notification L
[ 3. Owner's Name Last
----- i First
Owner's Address
/i [ h ��� �A�n r Owner's E-mail Address
�-iy 7 A.
L'1U.119�.T�1 ( State '
City _
- — ._ C� I Zip CP.e Telephone _�_ --
4. Archit Designer's Name Last s �l os
.•,_ry y. __ J First Lic. No.
Architect/De t ner's Address — \- �--�-'- '��L'� _:�--
11_771;n
p �r Architect/Designer's E-mail Address
-11711 C 1 .c -n.._ -
City
State Zip' '
[ 5. Engineer's Name
Telephone
�����Z�
,770
Last aJ
Last
First
Engineer's Address
City ----_ --- -- _
------ State �-
[6. Contractor's Name
Lic. No.
Engineer's E-mail Address ----
Zip Telephone
Last [ ,_
Contractor's Address
city
-�?irN,__.- State-Zp
OFFICE USE ONLY
TYPE OF CONSTRUCTION
OCCUPANCY -GROUP —
First—
Lic. No. 8�g28q Class
Contractor's E-mail Address J
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEE $
WA