HomeMy WebLinkAboutXR2023-0141 - Permit Application1_ _� Worksheet for Combo Building
Building
Application oF�� .a
Print Form EWro
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Comm'I j� Residential s
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL c „op .
jxBuilding F_ Grading F-Drainage r Elec rMech F- Plum CuYdCut F CuvdFill F
Project Address (Not mailing address) F Flood r' Fire F_ Liq F_ Landslide FN/A Floor Suite No
616 W 134�130A $l,Y�. �2661 �, r �—
Description of Work
Use ConstType }/• �•�
Fig
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# Stories5 # Units (if Res)
�IYIN.� S1Ph2� � (Aii' PUoYhi7mJ e� ��) q+1 SFSFD .
Valuation $
Material/Labor s ��
New/Add SF / model SF 5F Garage/New/Add F
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OWNER'S NAME Last t�k First
Owners Address Owner's E-mail Address
61b w r�M-gdA ��YO
City State �- Zip___1 264�( Telephonel—
APPLICANT'S NAME Last Cw( -M kl t First I N 1 Lq D ws
Applicant's Address Applicant's E-mail Address
260 [; MOVNt IAI 6�.f ST P6 L-FMA1ll e CbL,61AA�tj A", GOM
City W-f f Q tF {' State � Zip 96 v Telephone j-iy % �-$4
ARCHITECT/DESIGNER'S NAME Last CD b � �f First l (A10%/oiS Lic. No. G- 36 9'6�
Architect/Designer's Address Architect/Designer's E-mail Address
City State � Zip � Telephoner
ENGINEER'S NAME Last FirstF— Lic.No.F
Engineer's Address Engineer's E-mail Address
City � State �- Zip I Telephone
CONTRACTOR'S NAME/COMPANYr� C \ Lic No. b9rJc/ Class
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Contractor's Address Contractor's E-mail Address
z�t5 S. o� �S l
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City C� (1� State �— Zip 9zcTelephone Cjgq_Zc�__���
SETBACKS REAR SETBACKS FRONT PERMIT NO. �d1
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $