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HomeMy WebLinkAboutX2021-3098 - Permit Application (2)[—,Building Grading Drainage lec Mech Plum Cu yd curs Cu Yd Fills Project Address (Not mailing address) [ Flood r Fire J— Liq F_. Landslide [N/A Floor Suite No Ave Description ofWork Use onstType$ �Gifd1✓�oyH re #Stones # Units (if Res)s Valuation $ New/Add SF�— Remodel SF� Garage/New/Add F— Material/Labor OWNER'S NAME LastM ll AA 1 �1 First- Owner's Address qq Owner's E-mail Address �U Ci�tbr�0LiS2 City /WCipe'c BUtU� State v — Zip FqELG7 Telephone APPLICANT'S NAME Last First Applicant's Address Applicant's E-mail Address City - State— Zip Telephoned ARCHITECT/DESIGNER'S NAME Last First Lic. No. �— Architect/Designer's Address Architect/Designer's E-mail Address City State �— Zip Telephone- ENGINEER'S NAME�j R � Q Uh c�' e Last First �^ Lic. No. Engineers g .Engineer's E-mail Address J`J5._tIPY[v�i f_isV _c1��YV1 fct5^� GoVv� City i rl q yvState E Zip _{ 2 { Telephone { �J� CONTRACTOR'S NAMEICOMPANY �f' �c i� 0 Lic. No. gy d Class Contractor's Address Contractor's E-mail Address / o city C<<i�.`L� l G: �f State GL� Zip �� c 7 Telephone j r ci �- � � SET. BAC S REAR SETBACKS FRONT PERMIT NO. �2aZl 364 rt X6436 -2x2 1 ET S LEFT SETBACKS RIGHT PLAN CHECK N017 . f� SE 0. DEVELOPMENT NO PLAN CHECK FEES $ 266,OZ