HomeMy WebLinkAboutSW040180_Attachment - applicant information sheetPa 67 6' --2> —3
COUNTY OF ORANGE/PLANNING AND DEVELOPMENT SERVICES
APPLICANT'S INFORMATION SHEET FOR A BUILDING/GRADING PERMIT
Applicant must legibly PRINT in all of the known indicated information. PERMIT NUMBER:
n WrIT
f /,r �C-
BUILDING ADDRESS OF PR Number Street General Area
LEGAL DESCRIPTION OF PROJECT SITE: 6
Tract Bioek Lot
(it metes & bounds then you must provide a recorded copy of the Grant Deed.}
ASSESSOR'S PARCEL (AP) NO. ZONE
NEAREST CROSS STREETS: _
OWNERIBUSINESS NAME: 1
OWNER'S PRESENT ADDRESS: street
I / Number 1 Zip Phone No.
C;
'
General Area of County/City
SPECIAL PERMIT NUMBER'. use Permivsite PlanNariance
PROPOSED USE OF STRUCTURE: This must be clearly spelled out in detail as to exactly what is the intended
use. The terms "OFFICE" or "COMMERCIAL BUILDING' are NOT sufficient to determine ii the proposed use
meets the Zoning District Regulations, Occupancy Group, or if the TYPE OF CONSTRUCTION will permit the
STRUCTURE SIZE SQUARE FEET:
GARAGE SIZE SQUARE FEET:
CONTRACTOR:4 }
Number Strew. —
workers Comp
ARCHITECT-..
ENGINEER:
Name
Total
1 st Floor
2nd Floor 3rd Flc
SIZE SQUARE FEET
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-
License Number Glass cation
ne 1 1 -- C�r3-. �L S ('
Area/CitY Phorfe No.
Policy Number Date of Expiration
1 1 /
Li Number Sweet Are" _ Phone NO.
S T ru/ f t5
Lic No. Number Street Area/City Phone No.
' f
CONTACT PERSON: I�-- S AFFILIATION:
5� S PHONE #,r3—C ca. j E-MAIL,
FAX 0
APPLICABLE TO GRADING ONLY
SOIL ENGR: 1 1 Name Lic, No. Number Street 1 Area/City 1 Phone No,
ENGR. GEOL: r 1 I I
Name Lie. No. Number Street ArealCfty Phone No.
CALIOSHA REQUiREMENTSfCHECK APPLICABLE BOX: 0 1 am the owner -builder and exempt from state
permit requirements/0 I acknowledge that I must submit proof of issuance of CALIOSHA permit for the projectl
0 The project does not require a CAL/OSHA permit, based upon the criteria on the reverse side of this sheet.
I hereby certify that to the of my. wtaidgethe-information supplied on this information sheet is truand correct.
DATE
SIGNATURE: I . c.- - ° e't
roperty Owner Authorized Agent
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