HomeMy WebLinkAboutX2020-2214 - Permit Applicationn
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first ` LIC: No,.
Engineer's'E-mail Address
i ` Telephone
Contractor's Addressl
;Contractor s E-mail Addtess
City State
Zip Telephoned
SETBACKS REAR SETBACKS FRONT C
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
'USE
ZONE DEVELOPMENT NO
PLAN CHECK FEES $
X, Residential
wilding [ Grading
Address
Description of Work
New/Add
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL I
CDrainage T%flec
mailing addres
71 J.eW_p_DKT 6
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Use s Const Type s!,
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OWNER'SN"E— Lastl MUNI Firstl SI -AWN
Owner's Address
Owner's E-mail Address
051 Fift7ASUS ST
Pchshawr1@gm0Li'1•c0m
City N6-WMKT ,J3EA6f4 I
StateGf} Zip 012�((�Q Telephonegyggy.s$
DE\
'T NO
APPLICANT'S NAME Last I U N T I First I SHAWN
Applicant's Address
Applicant's E-mail Address
IIa51 19&MSt4S 5T
FOhshawn rnoi(1. com
City IN 6W Poecr 6eAC
State Zipg2�QIQQ Telephone GI Iq q ys 0s()5
ARCHITECT/DESIGNER'S NAME Last
First Lic. No.'53-LI�J
Architect/Designer's Address
�
®%L) ArchitecVDesigner's E-mail Address
21U5I DIIAWTZ PD
rA9TPIANQ98G5710bilrl- -?
City I WQaDHIAI,s I
StateG,7} 11 Zip 1 I¢4 i Telephone 8164123450
ENGINEER'S NAME Last �E��E�� FirstR�l(Q Lic.No.
Engineer's Address
Engineer's E-mail Address
12100 913 6 M fa sl
KPS i b e -VOL 0gma( l
,`
City S(An otI t 6`{
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Sate I /rl l Zip q I52 '; Telephonerat D q60 9W:52
CONTRACTOR'S NAME/COMPANY
Contractor's Address
City
Lic. No. Class
Contractor's E-mail Address
Telephones
SETBACKS REAR 2, 5
SE,
FRONT Z&
SETBACKS LEFT1
SE
'FIGHT cj
USE ZONE
DE\
'T NO
PERMIT NO. ADO 3o ✓ Z;V
PLAN CHECK NO. (1gZ��2
PLAN CHECK FEES $