HomeMy WebLinkAboutX2021-0068 - Permit Applicationf Comm1 r Residential U Ly UI +VCWPVIL UOdull - OUIlul y UIVIDIVII p y
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F -Building F_ Grading r -Drainage F_Elec [Mech F" Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) r Flood F Fire F_ Liq r Landslide [_N/A Floor Suite No
o)v?,s -. Vag-%,—
Description of Work
Use F Const Type F
# Stories[ # Units (if Res)
Valuation $
Material/Labor
New/Add SFr.-— Remodel SFF—
Garage/New/Add F—
OWNER'S NAME- Last 1Av4 1\
First W\aE-X
Owner's Address
Owner's E-mail Address
06'331 SLvni\er A e
11>UE'F -^w &Q APL-. Cow,
City PO c � State �! Zip QI u,( C) Telephone qqq aN gv5l q
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
`Z.C)a?j.\ TpV"LC4&VV
City I 1sJC%�,FLOeT \ JEtjz-tt State c0. -s
Zip [y( CD % J Telephone ®��alr�_..._-.S L 2
G L
ARCHITECT/DESIGNER'S NAME" /
Last GQ� ' ��� First �� Lic No.
Architect/Designer's Address
Architect/Designer's E-mail Address
-
Aa - In ackrce 4WN. C.,
City �+ State f
Zip Q� Z� Telephon a"(q)qT7-225^0
ENGINEER'S NAME Last
First Lic. No.Fi
Engineer's Address
Engineer's E-mail Address
City State ��
Zip Telephoned
CONTRACTOR'S NAME/COMPANY F
Lic. No. F Class
Contractor's Address
Contractor's E-mail Address
City State F_
Zip F_ Telephoned
SETBACKS REAR SETBACKS FRONT
PERMIT NO. L U®IQ�
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE '�-: DEVELOPMENT NO
PLAN CHECK FEES $