HomeMy WebLinkAboutX2019-4099 - Permit ApplicationPrint - I Worksheet for Combo BuildingoaB Building
Permit 11 �WP0
Pnnt Form � Rr
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NOTE: PLAN CHECK FEES DUE:AT TIME OF SUBf�711 TTAL ,<p00.0.
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Project Address (Not mailing address) F_ Flood r" Fire (— Liq j— Landslide CN/A Floor Suite No
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Description of Work
Use k% Const Ty -t'�I-
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# Stories, # Units (if Res)
Valuation $ ro
Material/Labor J
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OWNER'S NAME Last cbmrvyl " First
Owner's Address �J Owner's E-mail Address
City State �— Zip � � Telephone 00
APPLICANT'S NAME Last J�� `q S First N�
Applicant's Address Applicant's E-mail Address
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City —�n�/ j State Zip Telephone J +
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ARCHITECT/DESIGNER'S NAME Last _I-------- First
-I� To_ Lic. No.
Architect/Designer's Address Architect/Desigdl Address
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City _L V ��-—__---- _ -I State F—E� Zip �(Q j Telephone�_5Gf 0b
ENGINEER'S NAME Last First r� Lic. No.��
Engineer's Address Engineer's E-mail Address
City State ,,��I Zip I Telephone
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CONTRACTOR'S NAME/COMPANY t TA(jnLic. No. "Class�I
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Contractor's Address Contractor's E-mail Address
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City N jlt State J Zip — Telephone g4l6 �_IT4 W,
SETBACKS REAR SETBACKS FRONT PERMIT NO.�j�G�}Gi
CKS LEFT SETBACKS RIGHT PLAN CHECK NO.
NE DEVELOPMENT NO PLAN CHECK FEES $