HomeMy WebLinkAboutX2021-2405 - Permit ApplicationI Comm']Residential _"y .. .�..r - viviaiun I Z
_116NOTE: PLAN CHECK FEES DUE AT TIMF nF RI IRnnITTA PL
'Building r Grading 6rainage �P lec Mech I� I�
!.�`Itam Cu Yd Cutl Cu Yd Filll
Project Address (Not mailing address) F_ Flood r Fire F_- Liq F_ Landslide F_N/A Floor Suite No
Description of Work 1 I -? L��
Use Const Type
Arc -6 �"l�"
r # Stories # Units (if Res)F
Valuation $
7-
New/Add SF�G Remodel SF Garage/New/Add �— Material/Labor)
OWNER'S NAME Last /,I� s
First
Owner's Address Owner's E-mail Address
City�lt�3uv�;-K .f Jc�gt State o-,,�- ZipL��t Telephone
APPLICANT'S NAMEo
Last. foga rLc;m,;,r First � •'�
Applicant's Address Applicant's E-mail Address
City F State �— Zip Telephone—
ARCHITECT/DESIGNER'S NAME Last
Cj✓'NL%°c,�l FirstLic. No.
Architect/Designees Address Ar ch itectlDesignees E-mail Address
City State! ZiP ��, Telephone j )
ENGINEER'S NAME Lastvt First Lic. No.
Engineer's Address Engineer's E-mail Address
City State Zip Telephoned
CONTRACTOR'SNAME/COMPANY�y Lic. No. Class
Contractor's Address Contractor's E-mail Address
City State �— Zip F Telephone _
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.0 Z— 2
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $