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NOTE: PLAN CHECK
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Project Address (Not mailing address) F Flood r Fire r Liq F_ Landslide rN/A Floor Suite No
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Description of Work
Use ConstType
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# StorlesF _Z_ # Units (if Res)
Valuation $
Material/Labor lC%Co
New/Add SFF— Remodel SFF— Garage/New/Add
OWNER'S NAME Last L `I First ..i-t kk'- is
Owner's Address Owner's E-mail Address
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APPLICANT'S NAME Last First', u<2 M
Applicant's Address Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last First Lic. NoT_
Architect/Designer's Address Architect/Designer's E-mail Address
City State r-- Zip Telephoner
ENGINEER'S NAME Last First Lic. No. F_
Engineer's Address yw Engineer's E-mail Address
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City F State Zip F Telephone ON
CONTRACTOR'S NAME/COMPANY r��e�( Lic. No. c� 1 Class FAQ,
Contractor's Address Contractor's E-mail Address
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City l �C'_4 ( State ( Zip C1 Z( (p,7 Telephon `j C;2'7 GCS- � Lj Z.
SETBACKS REAR SETBACKS FRONT fnQ� -- �� / PERMIT NO. ..
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SETBACKS LEFT SETBACKS RIGHT IV
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $ -- L