HomeMy WebLinkAboutX2020-2252 - Permit Application'Pririt"Form I Worksheet fo`r Combo Building & S61dr• Pditlt-A` pN tioi5'"
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBM L oa
r"Building F_ Grading F -Drainage j-Elec F_Mech F_Plum CuvdCut cuvdFill F
Project Address (Not mailing address) f- Flood r- Fire [_ Liq FW Landslide F -N/A Floor Suite No
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Description of Work
Use F—Const Type F
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# StoriesF # Units (if Res)[—
New/Add SF Remodel SFF—' Garage/New/Add F—
Valuation $
Material/Labor
OWNER'S NAME Last � First _T
Owner's Address C/1 7 �s E-mail Address
City F State F— Zip F— Telephone—
APPLICANT'S NAME Last First
Applicant's Address (� Applicant's E-mail Address
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Cit State Zi , Telephone %/ o -773o
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ARCHITECT/DESIGNER'S NAME Last First F Lic. No. F_
Architect/Designer's Address Architect/Designer's E-mail Address
City I State F— Zip I TelephoneF�
ENGINEER'S NAME Last First Lic No.F—
Engineer's Address Engineer's E-mail Address
City State Zip �� TelephoneF
CONTRACTOR'S NAME/COMPANY Lic No.% FqS Zq Class
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Contractor's Address Contractor's E-mail Address [31 ;00 7Z q
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2- Z
F—
City State Zip Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. ��' 16 -Lo
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