HomeMy WebLinkAboutX2020-2574 - Permit ApplicationF Comm'[ F_ Residential
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) r Flood f- Fire F_ Liq f- Landslide FN/A Floor Suite No
Description of Work —
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New/Add SFF___Remodel SF � "^ Garage/New/Add Valuation $
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NAME
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Owner's Address
Owner's E-mail Address
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APPLICANT'S NAME Lash' --
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Applicant's Address ° -
Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME
Last .- First -
-- Lic. No.
Architect/DesigneesAddress Architect/Designer's E-mail Address
City
State Zip Telephoned
ENGINEER'S NAME LastCC
�Iv First ®'3 ® Lic. No. � 3{�
Engineer's Address
Engineer's E-mail Address
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CONTRACTOR'S NAME/COMPANY
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Contractor's Address
Contractor's E-mail Address
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City r State p `;
zip Telephone � 1 zE
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SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEES $