HomeMy WebLinkAboutPV2020-150 - Permit Applicationcomm i i nesiaentiai I I - _.- , --
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL \� :W -V
F -Building pr Grading
I—Drainage r Elec [7 Mech F- Plum cued Cutcu Yd Fill
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Project Address (Not mailing address) r Flood F- Fire F- Liq F! La FN/A Floor Suite No
Description of Work
Use I Const Type
# Stories # Units (if Res)
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Valuation $ 000
Material/Labor p
New/Add SF�
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Remodel SFF Garage/New/Add F—
OWNER'S NAME
Last First
Owner's Address
Owner's E-mail Address
City
State F Zip F Telephone
APPLICANT'S NAME
Last .C..t First_
Applicant's Address
Applicant's E-mail Address
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State �—
City r� 1. 1 �L
L� ge�"m
ZiP 9 6 -e� . 7e hone L01 `7% - lo
ARCHITECT/DESIGNER' AME Last First F - Lic. No.
Architect(Designer's Address
Architect/Designer's E-mail Address
City
State ZipF Telephone
ENGINEER'S NAME
Last i . . First—'; Lic. No.F_
Engineer's Address
Engineer's E-mail Address
City
State F Zip I Telephoner
CONTRACTOR'S NAME/COMPANYLic. No. J' Class
e - lag, .t.. P 2_ iib GIS
Contractor's Address
Contractor's E-mail Address
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City 11voh i �11 State �, Zip 'id�y 5 Teleph
f one _�077—['� t �tt
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $