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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBI
Building r Grading
Project Address (h
of Work
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F_ Flood r, Fire r' Liq
Cu Yd Fill
rN/A Floor
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Suite No
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Use(� Const Type R-3
# Storied' # Units (if Res)'
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New/Add SF �f��, Remodel SF �Ztiv Garage/New/Add
Valuationa
Material/Labor
�/b 600
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OWNER'S NAME LastlWa,*
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Owner's Address Owner's E-mail Address
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APPLICANTS NAME Last yi AG 'R(s:,Li
Applicant's Address
3l APt-ati-es r
City 14),SVPl,,y r ' State
ARCHITECT/DESIGNER'S NAME Last (lylq�g,c(
Architect(Designer's Address
City �wJ� 8 (� 4 t �1 State
First
Applicant's E-mail Address
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Telephone q !(
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zip Ftfu 7
First f�l Lic. No.
ArchitecNDesignees E-mail Address
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Zip 9a e Telephone 2 yf ygg9
ENGINEER'S NAME Last tt!/jaf S/j/jf pFirst Ftfe/1 /40 Lic. No. -7j` 00
Engineer's Address
City 5lil:;ui74 AA)A State
CONTRACTOR'S NAME/COMPANY
Contractor's Address
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City QwPOvIF ,�gg
_ (04t I State
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
Engineer's E-mail Address
Zip t? 70/ Telephone !7'(�7�
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Lic. No. 7w?f* ss j? /
Contractor's E-mail Address
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Zip ZOW'S'� Telephone [ y�.SO.7�jywg
PERMIT NO.
PLAN CHECK NO. 'Ietc( 6
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $