HomeMy WebLinkAboutX2017-1390 - Permit ApplicationDL -ca :0--Ia51 45b3r�2-
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Print Form rEWaa
LAN CHECK
ES
UE AT
Comm'I J-�sidential
Building jt7Gyading
f�'15rainage jr�ec fi/{ge�ch � Plum Cu Yd CutFq6 Cu Yd Fill �2 'GUD
Pr®pect Address
FN/A
(Not maliging address) rjDc&lr' Fire Liq r' Landslide Floor Suite Nlo
Description of Work
Use Const Type
# StoriesFf__# Units (if Res)IT-
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New/Add SF 5
Valuation $
Remodel SF�� Garage/New/Add L�d� Material/Labor C1
1444 5 G rfo.
OWNER'SNAME`
Last CJIMqS First l
wl'/I(•aN�
Owner's Address
Owner's E-mail Address `
City � .. Sk State Zip Telephone J51 7(32 �(+L
APPLICANT'S NAME
Last ,GUI &410 _ First / f'��q"�/\
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Applicant's Address _ _
_ _ _ _ Applicant's E-mail
City f
State ,..' Zip <7W. j/ Teleph(drie ��51r�
ARCHITECT/DE IGNER'S NAME Last 1../�✓ First I I.. ICI Lic. No.
Architect/Designer's Address
Arch itecVDesigner's E-mail Address
City I—
'. State F--'. Zip I TelephoneF_..
ENGINEER'S NAME
Last� r,1C,1\ First ' 7(,,, ( Lic No.
/ I
Engineer's Address
Engineer's E-mail Address
3
CityI %,,..,, ;)i
�j q J 1
463jr, State ,'. Zip {!j(Q`P TelephoneW�=65gG
CONTRACTOR'SNAAMMET//C�OMPAvN`Y"y( Lic.\No. �- -: Class
Address
Contractor's E-mail Address
rC�ontractor's
✓�,,�
City
.,.
State Zip - Telephone
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SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. O "ZGJ 15
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $
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