HomeMy WebLinkAboutX2021-3008 - Permit Applicationnes aentlal `- Y ui ivewport heath - Building Division X2021 - 3(xb&,� e
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL a
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yt3uilding �Grading F'Drainage FElec [ Mach Plum
Cu Yd Cut[ Cu Yd Fill
Project Address (Not mailing address) [ Flood f-, Fire F-; Liq F - Landslide( -N/A Floor
Suite No
escription of Work
��C�� Eio fP25 Use�Const Type .2- 5-1
ZD # StoriesF7 # Units (if Res)7'
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New/Add SF� Remodel SF 3 Z Garage/New/Add �- Valuation $
- Material/LaborF�lTq6 0 D
SOWNER'NAME -
Owner's Address
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City - . oa0t21 State FE
APPLICANT'S NAME Last
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Applicant's Address
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City DQ <4 State r
ARCHITECT/DESIGNER'S NAME
First 0
Owner's E-mail Address
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Zip 9 z-�6 3 Telephone (y� R 6 g O' q86 0 pi 715
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Applicant's E-mail/Address t
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Zip cj Z8 (� rJ Telephone z 133 6
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Last l� o M Et20 First DESA
Architect/Designer's Address
- - I _..- n LiC. No.
City tlNTIAIfToRi_._VJcACW State GQ
Archftect/Designer's E-mail Address
Zip .I 7 61 Telephone
ENGINEER'S NAME Last
First Lic. No. S S Z
Engineers Address -. ------.._.
Engineer's E-mail Address
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City - F n -
�} £ State Zip -- -
_-_ Telephone ��,q) 1146
CONTRACTOR'S NAME/COMPANY
M A1.2 CA Lc, a sTkJ.LTIno,_Iu Q . Lic. No. qQ 6-014. Class
Contractor's Address
„ Contractor's E-mail Address
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SETBACKS REA -- SETBACKS FRONT I
SETBACKS
PERMIT NO.
L T SETBACKS RIGHT �
PLAN CHECK N0. Z,617 _
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $