HomeMy WebLinkAboutX2022-0241 - Permit ApplicationPrint Form W(,U°ksheot for G®mb® Building & War Permit Applicafi®n
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r y o ewpo Vac - ul mg IVlsioV�'�,��I�
Comm'I Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SU I
F�Building F_ Grading F-Drainage [Elec F_Mech Plum Cuvdcut- CuvdFill
Project Address (Not mailing address) L_ Flood F_ Fire F7, Liq [- Landslide F_N/A Floor Suite No
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Description of Work
New/Add SF�
Garage/New/Add F-
Use onst Type
# Stori s # Units (if Res)F7
Valuation $ l
Material/Labor<x-Coo
OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
City State F—Zip[(f;D(,(,'3Tele hone -
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Addres
__
City.'----... State F7A
Zip �o��n� 3 Telephone 7100
ARCHITECT/DESIGNER'S NAME Last l
_.(-lh._? ^ ...._. __.............._. First ..._..._ Lic. No.
Arch itect/Deesigner's Address Architect/Designer's E-mail Address
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City `,.Q State Zip Telephone s^ ^ Sa 7%
ENGINEER'S NAME Last First Lic. No.
Engineer's Address Engineer's E-mail Address
S........... ..__..._. _..... ......... ...... .... ... ._......
. ....-.- ... _.... __.. _._-.__._ -... 1
City State F Zip Telephone
REAR
LEFT
SETBACKS FRONT
SETBACKS RIGHT
PERMIT NO.
PLAN CHECK NO
0 Z,- 1
e7 oD
tPNE DEVELOPMENT NO PLAN CHECK FEES $