HomeMy WebLinkAboutX2019-3576 - Permit ApplicationPrint Form Worksheet for Combo Building
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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-Material/Labor �OWNER'S NAMELast
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Owner's Address -- - - -- ---- -
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ARCHITECT/DESIGNER'S NAME Telephone 9[�r_ (�'_
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Architect/Designer's E-mail Address
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Telephone
ENGINEER'S NAME
Last
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Engineer's Address �1 36 YV 7
Engineer's E-mail Address
City - - -
State Zip [
Telephone��
CONTRACTOR'S NAME/COMPANY Contractor's Address Co �(y " Pr_ Cox e�, I UC f , O H Lic. No. �% /Z�J2�2_classr _ —
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SETBACKSREAR !
— SETBACKS FRONT p
SETBACKS LEFT -- SETBACKS RIGHT PERMIT NO. Xa 01 I _ 7 5 7 6
USE ZONE � PLAN CHECK NO.
DEVELOPMENT NO �
PLAN CHECK FEES $