HomeMy WebLinkAboutXR2023-2892 - Permit Applicationrint
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LAN CHECK
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(-Building r Grading
F-Drainage 1- Elec r Mech
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Project Address (Not mailing address) r- Flood
r Fire 1- Liq r Landslide FN/A Floor Suite No
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Description of Work
Use s ConstType �—
btMoc.IN0A1 of EAISTING 000s;
k Storiess ft Units (if Res)s
KEF.# 136262-3 -/l�ll 2 6` ¢oU - gh5q
.59 FT
Valuation
New/Add SF7-
Remodel SFF— Garage/New/Add
Ir
$ !'
Material/Labor 7— t 00G
OWNER'S NAME
Last 1-f 0ME—,>
First /3ALi?, }
Owner's Address
Owner's E-mail Address
2 UftfzPeNlFt
City ��1//yt/e
State FA
Zip YZ6 ZO Telephone 7/q — 6 Z 3
APPLICANT'S NAME
Last
First I A(_i-N,4t^/
Applicant's Address
Applicant's E-mail Address
City ip—mue
State Cep
Zip 924 ?,--) Telephone g 4y -75-O y 74c,
ARCHITECT/DESIGNER'S NAME Last
First F_ Lic. No. �—
Architect/Designer's Address
Architect/Designer's E-mail Address
City I
State F_
Zip F_ TelephoneF_
ENGINEER'S NAME
Last (/v rt��
First 7a(d to ) Lic No. U
i
Engineer's Address
Engineers E-mail Address
City
State F—
Zip � Telephone S 6�Z76,�
CONTRACTOR'SNAME/COMPANY n/E)-r �I1V& Lic. No. lo77&53 Class
Contractor's Address
Contractor's E-mail Address
C-Q P-1
City ��,v�,./)r
—
State Fz:�
62.
Zip 920 Telephone y9-750 -YZZ(
SETBACKS REAR
SETBACKS FRONT
PERMIT NO. )(RUM -MIX
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $