HomeMy WebLinkAboutEL161870_Application - QuestionaireToday's Date: / /-`3J ^,'� Permit #:
ARESIDENTIAL (RS)
❑ NON-RESIDENTIAL (NR)
❑ GRADING (Preliminary) (GA)
❑ GRADING (Precise) (GB)
❑ LANDSCAPING (LS)
❑ RESIDENTIAL TRACT (RT)*
❑ PENCE, WALL, RETAINING WALL (RW)*
*(Separate attachment required for multiple submittal)
❑ PLUMBING (PB)
❑ MECHANICAL (ME)
❑ ELECTRICAL (EL)
❑ SWIMMING (SW)
❑ SOLAR (SL)
❑ DEMOLITION (DM)
❑ SIGN (SB)
❑ OTHER
Legal Description: Assessor's Parcel Number (APN):
Location of Site (Decimal Degrees): /
Latitude _ Longitude
Project Description: v I 5r, 40 w•
STRUCTURE SIZE:
Total Basement
GARAGE SIZE SQUARE FEET:
Current Related Permits:
Owner Name:
SITE ACREAGE:
Phone Number:
Owner Address: ?f' -3,'p "KLei%-/ / ZO n ---
Address City Zip
Contractor: O cz,, / License l}:
Address:
Phone
Agent/Contact Person: 15�zc=�c• h¢/ kAl�lo, oi-, Affiliation: /Y---Z -I--
Phone Number: 9y `� `% o o o Fax: Email: VYi�el
ARCHITECT:
Floor
Name License # Street# City Phone #
ENGINEER: /
Name License # Street# City Phone #
SOILS ENGINEER:
Name License # Street# City Phone #
300 N. Flower Street, Santa Ana, CA 92703
P.O. Box 4048, Santa Ana, CA 92702-4048
wviw.ocplanning.net
P: 714.667.8888 1 F: 714.667.8885
nrnc„stomerCareta2ocow.oc0ov.com
GEOLOGIST:
Name License Streew city Phone#
CUBIC YARDAGE: CUT:
PROJECT ACERAGE:
FILL: EXPORT:
WATER DISCHARGE I.D. NUMBER (WDH)):
TOTAL SHE ACREAGE: DISTRIBUTED SITE ACREAGE:
W wf
❑ CPP PERMIT NOT REQUIRED 0 NO DECISION-ADDITI
TO BE SUBMITTED
E3 CPP pMArr FOR ENCROACHMENT PERMIT IS REQUIRED
0 CPP APPLICATION HAS BEEN SUBMITTED
PERMIT NUMBER:
CPP STAFF NAME:
DATE AND INITIAL:
I CERTIFY NO WORK SHALL OCCUR IN COUNTY RIGHT OF WAY AND/OR EASEMENTS.
Signature
TENANT/BUSINESS NAME:
OCCUPANCY PERMIT NUMBER:
SIGNAGE E]Wall Sign DFreestanding DSingle Face IlDouble Face 011lurninated
DETAIL:
Date
77
ONon-Illuminated
Height: Length: Sq Ft: Ground Clearance:
ADDITIONAL INFORMATION (i.e. Sign Copy):
kn-vr wpnrvr�-' -xrem-f we-�
771177�
DECLARATION:
I declare to the best of my knowledge that the information I have presented on this form and attached material is true and correct. I
also understand that additional data and information may be required prior to approval of this application and that insufficient
preview mf ti n1d ents may delay the plan pr w
7r7o7,cum7g,,-.
Print Name Sr tune Date
E] OTC ❑ PLAN CHECK [I PLANNING APPLICATION
ZONING: 0 Coastal
APN: 4-73 ice 0 Flood Plain
LEGAL: 1 S 1�-j —
PA/CP:
PLANNER'S NAME:
APPLICATION COMPLETE/
CUSTOMER CARE STAFF NAME
(per related cheeldist)
0 Required
0 CE
ACTUAL:
FRONT
SIDE (R)-
SIDE (L)
REAR_
INITIAL:
mxtr P �
DATE:
300 N. Fbmr Street, Santa Ana, CA 92703
P.O. Box 4048, Santa Ana, CA 927024048
- w .ocplannlng.net
P: 714.667.8888 1 F 714.667.88a5
oopCustomerGam@OcPw.ocgov.com