HomeMy WebLinkAboutX2021-3365 - Permit Application (3)1__ wuinii l7q nemuen❑ai � - --- _
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL _ yi v �vv u��oass
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g r Elec Mech Plum Cu Yd Cutl Cu Yd Fill
ss (Not mailing address) I- Flood r Fire r Liq j- Landslide N/Afr—Floc
S (IJ�<W �cor Suite No
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Description of Work - - - - - -
C✓ LTG DL�tOL1T10t Use ConstTypeF
# Stories # Units (if Res)
New/Add SF F_ Remodel SF�—GaraValuation $ tK &100,
Garage/New/Add Material/Labor
OWNER'S NAME LasFirst SAN
Owner's Address
Owner's E-mail Address
City iaiJk9q }3L;}} State- Zlp?L�63 Telephone—
APPLICANT'S NAME Last Pov"i-6T'A)h'ij,r First/ - --
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Applicant's Address Applicant's E-mail Address
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city/} r Ld:SP� State Cies ZIP C Z�%(� Telephone (`I'igj) 3yo-NL -
ARCHITECT/DESIGNER'S NAME Last M5 I�c�jC r
chFX9%Q First C-- Lic. No �-
Architect/Designer's Address j t G . AkaR 3 t: Architect/Designer's E-mail Address
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r -- State C } Zip F _ Telephone
ENGINEER'S NAME Last First Lic. Nof�
Engineer's Address Engineers E-mail Address
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City State Zip Telephoner
CONTRACTOR'S NAME/COMPANY P�9�9tP n -
vi% is tU i i,ls T, 5 Lic No. Class
Contractors Address Contractors E-mail Address 3Z7(? 6 d
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City co_ , I � P -C -SA State GPc Zip F-j,2-�, Telephone
SETBACKS REAR SETBACKS FRONT PERMIT N0. ZoZ A -3365
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO:
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $