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--' 'Vuilding F_ Grading F—Drainage F_ Elec F_ Mech Plum C. Yd CLt F_ Cu Yd Fill
Project Address (Not mailing address) [_ Flood Fire F_ Liq F_ Landslide F_N/A Floor Suite No
FT_ 7-
Description of Work A *,r, /A
Use
OWNER'S NAME Last First
State
tyl ZIP Telephone[
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
C't4�_ State Zip Telephone F
Last First �,4 AJO
ArchitectlDesigner's Address ArchitectJDesigner's E-mail Address
C ity e F_
ENGINEER'S NAME Last First Lic. No.
Engineer's Address Engineer's E-mail Address
city State F Zip Telephone
CONTRACTOR'S NAMEXOMPANY Lic. No. Class
Contractor's Address Contractor's E-mail Address
city State F_ Zip TelephoneF
SETBACKS REAR SETBACKS FRONT PERMIT NO,
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $