HomeMy WebLinkAboutX2017-3883 - Permit Application (2)'
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"New/Add SF�
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Valuation $
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OWNER'S NAME
Last
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Owner's Address
:Owners E-mail Address
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.State Zip Telephoned
APPLICANTS NAME
Last r Firstf_
Applicant's Address
"- Applicant's E-mail Address
' city
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State �— Zip Telephoner
ARCHITECT/DESIGNER'S NAME Last
First
— Lic. NoT
' Architect(Designers Address
Architect/Designer's E-mail Address
city, State �— Zip
F—! Telephoned
ENGINEER'S NAME
Last First— Lic. No.
Engineers Address
Engineers E-mail Address
;City State Zip F— Telephone-
CONTRACTOR'S NAME/COMPANY oD c;) J 13 Lic. No. �j��Class
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Contractor's Addre_ssss�[
Contractors E-mail Address
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State E Zip F— Telephone {71��
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $