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WHO MAY APPLY 7 <br /> FOwnerW <br /> E OWNER OF THE PROPERTY OR A LICENSED CONTRACTOR MAY TAKE OUT BUILDING PERMITb,. <br /> must submit the following with the application: Contractor must submit the following with the application: <br /> rty tax statement or a recorded deed a Current license numbers and a worker's cornpensatioi, <br /> e A completed and signed"Owner-Builder Verification"form insuranoe certification (this is not necessary if this information is <br /> A completed"Authorization for Application"form if other than already on file with the Department) <br /> the owner applies e A waiver form if the contractor is not subject to worker's <br /> compensation laws <br /> e 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: 6 R210 F_ �� L/(v'I'✓r <br /> APN: _ <br /> Cross-Street: 8y+ j� city: S � �� ZIP: <br /> Precise Location: �� � � �,- .„�p � ✓c-� �� <br /> Subdivision Name: Map# BULot# <br /> J <br /> Zoning and Setbacks Zone: Front: -36F <br /> Left: j i ht: Rear: 7.9 Height: -- <br /> School District: Fire District: <br /> �. — 0 <br /> Sewer District: Water District: c,�, <br /> Approved Use: r �� J <br /> Site Plan Type Hazardous Materials Survey Submitted: Yes: No: ❑ <br /> MINOR GENERAL:❑ MAJOR:L3 NIA:C3 answer is no-Please explain: <br /> rRaLnningProject(SA,UP, MS etc,)Expiration date: <br /> DAY YEAR <br /> SPECIAL AREAS <br /> Subsidence Area:Yes: ❑ No:,�d' Ex <br /> pansive Soil Area: Yes: No: ❑ <br /> Fire Hazard Area:Yes>0 No: ❑ Airport Zone: Yes: ❑ Nom <br /> Ente rise Zone: Yes: ❑ No: ❑ SJAFCA: Yes: ❑ No: <br /> BUSINESS LICENSE <br /> Re uired: Yes: ❑ No: ❑ BL No.: Fee Paid: Yes: ❑ No: ❑ <br /> COMMENTS <br /> Za tg <br /> L <br /> � <br /> 4ni '7 = "Ik 7 �? 9. a <br /> )L1'/F= = � kSF je — Z24 <br /> Q�o <br /> .3� <br /> Plan Check OnlyYES <br /> Technician: Qate: <br /> F:8UAZ14GVW4o0UrftF ffAM-ooM#& � <br /> RQ&.WCFier125{a ,a iaao-W) Page 2 of 5 <br />