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WHO MAY APPLY? <br /> ONLY THE OWNER OF THE PR ERTY OR A LICENSED CONTRACTOR 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 workers compensation. <br /> • A completed and signed"Owner-Builder Verification"form insurance certification(this is not necessary if this information is <br /> • A completed"Authorization for Application"forth if other than already on file with the Department) <br /> the owner applies • A waiver forth 'rf the contractor is not subject to workers <br /> compensation laws <br /> • A completed "Authorized to Sign" forth it other than the <br /> contractor applies (this is not necessary it 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: i LL APN:;.^ U <br /> Cross-Street: n/ t2 100'^ 121d <br /> // C' : 1 ZIP: <br /> Precise Location: <br /> Subdivision Name: -- map# BULoW <br /> Zoning and Setbacks Zone: Front q 0 Left: 40 Right- Rear: Height <br /> School District: 6W„ /I Fire District: <br /> Sewer District 7r Water District: <br /> Approved U- A . t f <br /> Site Plan ype Hazardous Materials Survey Submitted: Yeg-4 No: ❑ <br /> MINORX GENERAL:❑ MAJOR:O WA:❑ If answer is no-Please explain: <br /> Planning Project(SA,U , MS etc.) ration date. <br /> ,1, trr,a� <br /> MONTH I DAY <br /> v SPECIAL AREAS <br /> Subsidence Area:Yes: ❑ No:X7 Expansive Soil Area: Yes: ❑ No: <br /> Fire Hazard Area:Yes:.;,( No: ❑ Airport Zone: Yes: ❑ No: gr <br /> Enterprise Zone: Yes: ❑ No: SJAFCA: Yes: ❑ No:;1� <br /> BUSINESS LICENSE <br /> Required: Yes' No: ❑ BL No.: I Fee Paid: Yes: ❑ No: ❑ <br /> COMMENTS ?a <br /> SFA a — Z3 07 IMF= X00 <br /> R i lr = Soo <br /> t14D, w zua e <br /> o7Go B <br /> i = 3 So k 'l� � f LS — ?-C1 /2//4,/0-7 <br /> Plan Check Onty YES <br /> Technician: Date: <br /> v euanwcvunoo�rtwtr•�n aw-�r:cur.wx vw•lz rn..wa 1Ud W) Page 2 of 5 <br />