HomeMy WebLinkAboutX2021-3361 - Permit ApplicationW. Drinf C^r I L11r...1—L-4- i-- r+_.._1_- M..:r o [._r_.- M____�
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PLAN CHECK FEES DUE AT TIME OF SUBMITTALI
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F—Building F— Grading ramage fi Elec /r Mech Plum - M, Fma tCu F i
Project Address (Not mailing address) C Flood Fire F-, LIq F_ Landslide CN/A e
Description of Wor
Use onst Type
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# Storie # Units (if
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SF , rn F I 12 Gara a/New/Add
Valuation $ POO/,tmNew/Add
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OWNER'S NAME Last D First `
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Owner's Address Owner's E-mail Address
City--f�►P�r )�r� lX� ` State I CT Zip 63— Telephonejy�%�>%rd:Al/a
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APPLICANT'S NAME Last TGl S1lb , First
Applicant's Address Applicant's E-mail Address
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city NpAnl p State Zip I " �`l.O Telephone ✓�� tt1 U-1�6D
ARCHITECTMESIGNER'S NAME A^ ,1
Last e,�pr/;`,k First Lic.No. �—
A``rch�itecct/Designer's Address Architect/Designer's E-mail Address
City,_ _ — State s�'�ji� Zip Telephone
ENGINEER'S NAME Last
--��Nd 1 First �d ✓ Lic. No.
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Engineers,Address Engineer's E-mail Address
City Ei ) G S S>� r �� Zip i O I Telephone t� �`� _ 7j2�s �•L
CONTRACTOR'S NAME/COMPANY Lic No. F Class
Contractors Address Contractor's E-mail Address
City State F_— Zip F Telephoned {/�e 1 TJAL
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SETBACKS REAR SETBACKS FRONT PERMIT NO. I"
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK N0.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $