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X2021-1220 - Permit Application
1 L Zipr �`2i Telephone q�q. 6�z'3s8 City 77 ^ State L�" T ]" ARCHITEC EJIGNER AME Last f3� � First �f Lia No.7_7 'Architect/DesignersAdiress Architect/Designer's E-mail Address 65- Cityd—� State—I Zip jfo2 Telephoner6`�2 3 68 ENGINEER'S.NAME Last First Z2I xt-&GLic. No, F� �Engine6r`s P,ddreis - `Engineer's,E-mail) A—ddress Ffd�C1�c� 1 es' t tt:-G —I .: �i.11�}�(� �?c�;`Y •.GOi City State Zip' `jam© Telephone'7p CONTRACTOR'S NAME/COMPANY Lic No. Class Co ractor's Address Contractor's E-mail Address � u-/ N/J 10 City_ State Zip Telephone ���._ r �LiI NO. SETBACKS REAR C2 SETBACKS FRONT PERMIT SETBACKS LEFT SETBACKS RIGHT % ( PLAN CHECK NO. 1) USE ZONEI "CROOK DEVELOPMENT 140 PLAN CHECK FEES $ 1