HomeMy WebLinkAboutX2021-0327 - Permit ApplicationNU i t: VLAN GMtOK FEES DUE AT TIME OF SUBMITTAL
Building Grading F—Drainage rElec rMech )—Plum Cu Yd Cut
Cu Yd Fill
Project Address (Not mailing address) Flood Fire F` Liq r— Landslide rN/A floor
Suite No
V15 -'sirTz
Description of Work
Use F Const Type
!2/o L/ �J/ r/vr� �T/rSl
# Stories[— # Units (if Res)
New/Add SF � Remodel SF�— Valtuation
al/La$
Garage/New/Add Ma�— eribor
OWNER'S NAME Last rr
First
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Owner's Address -
Owner's E-mail Address
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city.
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Zi / Telephone7����1f3
APPLICANT'S NAME Last "A
First /N
Applicant's Address
Applicant's E-mail Address
City tA� State
Zip
. Telephone®
ARCHITECT/DESIGNER'S NAME Last
First F Lic. No. FjO
Architect/Designer's Address Architect/Designer's E-mail Address
city
State F Zlp� Telephone
ENGINEER'S NAME Last�y 9
!�/ `�� First �� Lic. No.
Engineer's Address Engineers E-mail Address
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Clty / � State � Zip
F�p�� Telephon �3`fj 7i�
CONTRACTOR'S NAME/COMPANY �`
Lic. No. I Class—
Contractor's Address Contractor's E-mail Address
City l�
State �— Zip Telephoned--'.
SETBACKS REAR SETBACKS FRONT
PERMIT NO. -
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $