HomeMy WebLinkAboutX2018-2971 - Permit ApplicationPrint Form Worksheet for Combo Building & So �rftr i�Application ���WP°Rr;
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r_ comm'I Residential NOTE: PLAN CHECKoF ES DUE ATiTdIiME OFISUBMIL �'� u h +< F`
wilding ❑ Grading F-"Drainage ,j�Elec %Meth ❑ Plum Cu Yd Cute Cu Yd Fill
Project Address (Not mailing address) ❑Flood ❑Fire ❑ Liq [-J Landslide CIN/A Floor Suite No
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Description of Work j
Use _ � Vonst Type
(if Res)
.�s,�.. # Storri� #Units if Res)
New/Add SF I
OWNER'S NAME
Owner's Address
Remodel SIF
Last _,� I FirstP/
Owner's E-mail Address
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City 1/jJ�� J- State Zip Telephone
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APPLICANT'S NAME Last _ WI_ First
IVbluition
$ l6x90
Material/Labor
Applicant's Address
City '—iState �4
Applicant's E-mail Address
I * // -- e,22- al1
Zip _5�z Telephone
ARCHITECT/DESIGNER'S NAME
Last k First
Lic. No.�
Architect/Designer's Address
City („�p�(E; �.� l State
ENGINEER'S NAME Last
Engineer's Address t
J1 AVE
City G 6Ar _ State CG4 ,
Architect/Designer's E-mail Address
i'-5A L o�Mi4GG �G6�1
Zip[ Telephone
First F;A R6,01 rC> _l Lic. No.
Engineer's E-mail Address *-
Zip d rid Telephone
CONTRACTOR'S NAME/COMPANY y, &O UG-FI O / I Lic. No. J ClassF-1
Contractor's Address
City State C dui Zip
SETBACKS REAR SETBACKS FRONT
LEFT
SETBACKS RIGHT
DEVELOPMENT NO
Contractor's E-mail Address
Telephone % /
PERMIT NO. A �'v L v -
PLAN CHECK NO.
PLAN CHECK FEES $