HomeMy WebLinkAboutX2021-0311 - Permit Application-
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMI �R 4 1
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Project Address (Not mailing address) ❑ Flood [7 Fire F, Liq F1 Landslide F–
JN/A Floor
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New/Add SF[ --7__:7, Remodel SF F Garage/New/Add
OWNER'S NAME Last
Owner's Address
City State
APPLICANT'S NAME Last
Applicant's Address
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Owners E-mail Address
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Applicant's E-mail Address
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Zip Telephone- (1019 G3 E5
ARCHITECT/DESIGNER'S NAME Last [ Bon me, FirstfYl r chore I Lic. No.
Architect/Designer's Address
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Architect/Designer's E-mail Address
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ENGINEER'S NAME Last FIrstF_ Lic. No.
Engineer's Address
City State
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Engineers E-mail Address
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Zip TelephoneF
CONTRACTOR'S NAME/COMPANY Lic. No. Class F
Contractor's Address Contractor's Email Address
City State Zip [77777 TelephoneF77777
SETBACKS REAR.— SETBACKS FRONT PERMIT NO.
2
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $