HomeMy WebLinkAboutX2021-1803 - Permit ApplicationComm'I Worksheet for Combo Butilding-& Building
rVPioermit Application 04W
Print Form 'r Residential City p gNOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building Grading F-Drainage j Ilec r'Mech
v
/plum cuvdCut CuYdFill F
Project Address (Not mailing address) F_ Flood F_ Fire F Liq F- Landslide rN/A Floor Suite No
Description of Work
Use F—Const Type I
S Cd 1
Cup
(tI r
# Stories #Units (if Res)
r�,�(
'' 11
UFS Sit -J Va-1 R
L.T'11S T� S lr �o-te
` 1
9 Ilj It �l"i �i
Valuation 5
Material/Labor GZ1
New/Add SFr_ Remodel SFr Garage/New/Add
OWNER'S NAME Last r-1
, �U S �s
lY
First j-�-� „7 t 1
Owner's Address
Owner's E-mail Address
il� 0t.,� Lai-
-
City � j �
State
Zip[ 3 Telephoned
APPLICANT'S NAME Last
�� -
C-C.
First A
Applicant's Address
Applicant's E-mail Address
City I._--
State
Zip F- Telephone�—
ARCHITECT/DESIGNER'S NAME
Last ��—
- irst I-'----� Lic. No. F
Architect/Designer's Address
Architect/ g r' E-m it re
City
State I--
Zip [ Telephoner
ENGINEER'S NAME Last
First Lic. No.F�
Engineers Address
Engineer's m it A re
City �—
State F_
Zip [_ Telephone[—
CONTRACTOR'S NAME/COMPANY
l,c: Lti1 5 Lic. No. 5�'1 �7 Class
Contractor's Address
Contractor's E-mail Address
cV T
city�-
(' i.,; ( ,Ur-
4tz/_( t)
,I.
StateC
Zip L� Telephone
4v- 4 j � 5o - �9 r{
SETBACKS REAR
SETBACKS FRONT
PERMITNO.j�
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO. t1 '1� 7
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $