HomeMy WebLinkAboutS2020-0210 - Permit Applicationwr„ .
"' Worksheet for Oe111W Residential ort each
Building A
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ing F_ Grading — o
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Drainage
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ject Address (Not mailing address) r- Flood F_ Fire F_ Liq F_ Landslide CN/A Floor Suite No
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OWNER'S NAME Last LAVJEC2
Owner's Address
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City 1PPw / ,,t -&0,d,State Fr
Use F Const Type
# StoriesF # Units (if Res)r
Valuation $
Material/Labor /�1•Y�ti�rwr
First /t1_ovs�
Owner's E-mail Address
ZIP Telenhnno
APPLICANT'S NAME Last r d
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Applicant's Address / � -„/
21 IC Z Applicant's E-mail Address
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City // ✓_ State
(% �- ZIP' L'qj Z Telephone / TV) —Z- YJ
ARCHITECT/DESIGNER'S NAME
Last Firs - ,
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Lic. No. �I
Architect/Designer's Address Architect/De ' s E-mail Address
City State
ZIP 2(f lephone - 'G
ENGINEER'S NAME Last �/D-� T,��
First f O Lic. No,
Engineer's Address Engineer's E-mail Address 40
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City Al _ _ State 1 ZiP �i 2(rQ� Telephone ��
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CONTRACTOR'S NAME/COMPANY /r i� �,� 1�� Q � 0 r- --
Lic. No. Class) yQ
Contractor's Address Contractor's E-mail Address
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City
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SETBACKS REAR SETBACKS FRONT u 006 0A , 0
PERMIT NO. ��+W
SETBACKS LEFT SETBACKS RIGUADWI PLAN CHECK N0:1 t, 41
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