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f <br /> WHO MAY APPLY? <br /> ONLY THE OWNER OF THE PROPERTY OR A LICENSED CONTRACTOR MAY TAKE OUT BUILDING PERMITS. <br /> Owner-Builder must submit the following with the application: Contractor must submit the following with the application: <br /> • A property tax statement or a recorded deed • Current license numbers and a worker's compensation <br /> r • A completed and signed"Owner-Builder Verification"form insurance certification (this is not necessary if this information <br /> • A completed"Authorization for Application"form if other than is already on file with the Department) <br /> the owner applies • A waiver form if the contractor is not subject to worker's <br /> compensation laws <br /> • A completed"Authorized to Sign"form if other than the <br /> contractor applies(this is not necessary if this information is . <br /> already on file with the Department) <br /> THIS PAGE TO BE FILLED OUT BY DEVELOPMENT SERVICES STAFF <br /> PROPERTY INFORMATION <br /> Job-Site Address: L �;� '� jQ jjQ APN: ` <br /> Cross-Street: }1"a 1L City: oct OAJ ZIP: <br /> Precise'Locabon: w ei 51 le Zk1--L ' U 14e af AJ4__ � <br /> ter.n � • o <br /> Subdivision Name: �?' Oaf.14s h„ HA # BIILot# <br /> Zoning and Setbacks Zone: Front: -3 0 Left: 10 Right: U Rear. 'j,') Height:.'. <br /> School District: +C <br /> .e P. Fire District; <br /> Sewer District, ) Water District: <br /> Approved Llsei , <br /> Site Plan Type Hazardous Materials Survey Submitted: Yes: ❑ <br /> MINOR:❑ GENERAL:❑ MAJOR: ❑ N/IF�V If answer is no-Please explain: <br /> Planning Project(SA,4P, MS etc.)Expiration date, <br /> MONTH DAY YEAR <br /> SPECIAL AREAS <br /> Subsidence Area:Yes: 0 0. Expansive Soil Area: Ye No: ❑ <br /> Fire Hazard Area:Y No: ❑ Ai rt Zone: Yes: ❑ N" <br /> Enter rise Zone: Yes: ❑ N SJAFCA: Yes: ❑ N ' <br /> BUSINESS LICENSE <br /> Required: Yes: ❑ No: ❑ BL No.: Fee Paid: Yes: 0 No: ❑ <br /> COMMENTS $ <br /> rP.O <br /> 1 f o�e t <br /> ND.ttV'C�?r ERaNQ _.I Lh WAR W v`Ebl. <br /> my yr tile applicant <br /> Ca;rntyLOrdinar�ce Code Division 7, Land Leveling and interference with <br /> Water LZurses,Sactions <br /> Plan Check Only YES APPROVT FOR GRADING UNL : File# <br /> Technician: L 11 <br /> Date BY I Date: I U o <br /> F:7BuftnglriandoutOPERMiTAPP-GRAOINGAd file PiZa(Re iw 12-24-0) Page 2 of 2 <br /> 4 <br />