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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 /> • A completed and signed"Owner-Builder Verification"form insurance 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 • A waiver forth if 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 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: 1 S APN: - -1 T6 -3 <br /> Cross-Street city: S62 ellZIP: <br /> Precise Location: Df Caetz6-AZ <br /> - <br /> Subdivision Name: Map# BI/Lot# <br /> Zoning and Setbacks Zone: GJ Front 370 Left: R' ht: Rear: 4�,- Height: /W <br /> School District: S Fire District: <br /> Sewer District: Water District <br /> Approved Use: S <br /> Site Plan Type Hazardous Materials Survey Submitted: Yes:� No: ❑ <br /> MINOR:❑ GENERAL:r3 MAJOR:❑ N/A:O If answer is no-Please explain: <br /> Planning Project(SA, UP, MS etc.)Expiration date: <br /> i 2-J z"9 <br /> MONTH DAY YEAR <br /> / SPECIAL AREAS <br /> Subsidence Area:Yes: (3 No: f3 Expansive Soil Area: Yes: No: ❑ <br /> Fire Hazard Area:Yes: ❑ No: 0' Airport Zone: Yes: ❑ No:4 <br /> Enterprise Zone: Yes: W' No: ❑ SJAFCA: Yes:aO' No: O. <br /> BUSINESS LICENSE <br /> Required: Yes: Z'No: ❑ BL No.: Fee Paid: Yes: ❑ No: ❑ <br /> COMMENTS - <br /> � S L <br /> 4~2-oZ <br /> Plan Check Onl YES File# <br /> Technician: Date: <br /> v.,um+wWANDDA Enmur,_w�M-MVw,'Qw ) Page 2 of 5 <br />