HomeMy WebLinkAboutX2019-2415 - Permit Application (3)9 [—Drainage OTE: PLAN CHECK FEES DUE AT TIME OF SUBMIT fill— v -I I�
rBuiIding r Gradin f g VElec f— ech
Y°M jemPlum Cu Yd Cut Cu Yd Fin
Project Address (Not mailing address) f `Flood f Fire (— Liq (°Landslide I�N/A Ftoor
/ y Suite No
Description of Work
/
i � 1 �f -5,F s Use Const Type
aL._ y n # StoriesF
I#Units (if Res)r(
New/Add SF fiemodel SF Valuation $
�� Garage/New/Add Material/Labor
OWNER'S NAME(
Last
..Owner's Address First
Owner's E-mail Address
City State ZIP Telephone
APPLICANT'S NAME Las
First
Applicant's Address
Applicant's E-mail Address "
C Y State I----�—�
Zip— Telephoner__—r
A CHITECT/DESIGNER'S NAME
Last / :First
��r(G $lel v�y— Lic. No.
Ar tect/Designer's Address
Architect/Designer's E-mail Address
L31�� L4 L %cvlc L7_ i,c fC i
City L��
Cga,ulfs State (.,t+� Zip �' at,\
( 2� Telephoned
ENGINEER'S NAME Last
Engineers Address r—r— j
�i 15;6i First r�
�l&r• Lic. No.�
�, /`��'
Engineer's E-mail Address FEE
City / i vC ; x y
L6'Zr� fi6� s State r Zip iEs T Telephone
I
CONTRACTOR'S NAME/COMPANY ;
Lic. No. F4 Class
Contractor's Address �
Contractor's E-mail Address
i
City
State - Zip TelephoneF�—_�-
SETBACKS REAR 115.1 SETBACKS FRONT
SETBACKS LEFT
SETBACKS RIGHT
USE ZONE — PLAN CHECK NO. ��.01 a .�
DEVELOPMENT NO
4 PLAN CHECK FEES $ / of
m