HomeMy WebLinkAboutXR2023-0749 - Permit ApplicationF-[omm1 F7Re�idenda| C�/nf 8euch'Bui|dingDivision /t ~/`~7��Q
[—Building F_ Grading -Drainage Elec Mech plum Cu Yd Fill
r Cu Yd Cut
Project Address (Not mailing address) F_ Flood F_ Fire Liq Landslide FN/A 1()
IF or Suite No
Description of Work
Use F7 ConstType F_
Material/Labor
New/Add SFF Remodel SFF Garage/New/Add
1 7?;_731, 0_0
OWNER'S NAME Last First [ :50-54AIA J,4/P
Owner's Address Owner's E-mail Address
city State 4!!A Zip Telephone 14�_
APPLICANT'S NAME Last First I -JAM e 5
Applicant's Address Applicants E-mail Address
State elephone
ARCHITECT/DESIGNER'S NAME Last L First F Lic. No,
Architect/Designer's Address Architect/Designers E-mail Address
ENGINEER'S NAME Last F 5a r IN 5t?ae First Lic. No. F—
Engineer's Address Engineer's E-mail Address
City State zip TeleiphoneF
CONTRACTOR'S NAME/COMPANY Lic. No. Class
Contractors Address Contractors E-mail Address
city state Zip Telephonel
SETBACKSREAR SETBACKS FRONT PERMIT NO. 2�ZaZ—,
SETBACKSLEFT SETBACKS RIGHT PLANCHECKNO.
USE ZONE DEVELOPMENT NO PLANCHECKFEES$