HomeMy WebLinkAboutEL080611_Application - QuestionaireRDMD/Development Processing Center Permit 0 L�Q
BUILDING PERMIT QUESTIONNAIRE
❑ RESIDENTIAL (RS)
❑ COMMERCIAL (NR)
❑ SWIMMING POOUSPA (SW/SA) — ALSO NEED TO FILL OUT QUESTIONNAIRE
❑ ELECTRICAL
❑ MECHANICAL
❑ PLUMBING [] Non -Structural (EL, PB, ME, Combo)
❑ RETAINING WALL — SEPARATE ATTACHMENT REQUIRED FOR MULTIPLE WALL SUBMITTAL
Ildlnp Address of Project: 3 l/EG// Ati S !?/7 -
arest Cross Streets: PL_-i1/R1a 1-has Pp, /1'1-arrr
vner Name:
vner Address
vner Phone Number:
rrrent Permits: 48 U7000 -7
antnetor:rx aN OriyrC_ DcvrcaPin�ti� License N
Idress: J8557_ /MReA27-dzrz_ &vo �'102, T7¢✓iniC Phone# (9y11)2a8—ir937
antect Person: J,-AAI Affiliation:
ionel4t ��Jy �2� —893� Fax# (y7�1�833-89.1�
Ph Description:
E-Mail:
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rRUCTURE SIZE:
ToW 1 hoar 2"'noor r now
ARAGE S1ZE SQUARE FEET SITE ACREAGE
�tCHITECT: I I I
Phone Number
VGINEER: / /
Name Uc. No. Number Shah Ar"Clty Phone Number
STAFF USE
DNI NG:
:IN#:
GAL:
>:
�CESSORYSTRUCTURES
ECLARATION:
ACTUAL
FRONT _
SIDE
REAR
LOT COVERAGE
REO'D
eclairs that the foregoing is a true and correct to the best of my knowledge. I understand that an incorrect answer will cause
lay to inspect on approval and issuance of a stop -work order.
Pnnl name Signet& Date