HomeMy WebLinkAboutX2021-3368 - Permit Application (3)Worksheet for Comobo Bouilding &dog Dr Permit Application ol� "
Print Form FIrI EWPo
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j- Comm'I r Residential City NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL X X)D ' 3,3 68 u r
f Building r Grading j—Drainage F_ Elec j- Mech F- Plum Cu vd cut Cu vd Fill
.._.....___...........__._.
Project Address (Not mailing address) fFlood Fire f - Liq f7 Landslide N/A Floor Suite No
Description of Work Use F7. Const Type F_
-' ``��•• r , / U /� q # Stories. # Units (if Res)
U l V 1 i1� . U_V / 0&1 L i. �1[_.�! At _UV t�A) I A flr<:
Applicant's Address
City�C.1%N1i...State CA�'
Applicant's E-mail Address
Zip �Z(o^ Telephone r] 5►�, S�j7 Z/ j
A GNER'S NA Last) I-PJ First
-- Lic. No.
Architect/Designer's Address
120�
City `j��/V Ck)V!NI,0jV--F_ State t N.A
Architect/Designer's E-mail Address
e. c c�c ,
Zip ��? TelephonerrCf Y1, szl? -774q 6
ENGINEER'S NAME Last
J�i�Jt�-lif�L� First . Lic.No..
Engineer's Address
7 1T 41L�} % L 41,\J CQ
City al i L_ 1i% State
Engineer's E-mail Address
Zip q'Z(o I b .; Telephone 4 qq •&go -31 (p�3/ Ch
CONTRACTOR'S NAME/COMPANY C�[X • Lic. No. _ 673aU Class
Contractor's Address
12t'31a4� C a
city I lj� State
Contractor's E-mail Address
fix_,
Zip �� Telephone I' 6/1f, 53�•
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT
SETBACKS RIGHT
USE ZONE nG\iGi n[DRA n= r Kin
PERMIT NO.
PLAN CHECK NO.