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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 <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 isnot 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: y p nn S�t �IAv lu APN: a�- Q <br /> PA - <br /> Cross-Street: .` �^ f C' ZIP: <br /> Precise Location: bWye. A 3 <br /> Subdivision Name: Map# BVLot# — <br /> Zoning and Setbacks Zone: Front: 3 Left: Right: Rear: Height: <br /> School District A4SC 'd Fire District: <br /> Sewer District: Water District: <br /> Approved Use: <br /> Site Plan Type Hazardous Materials Survey Submitted: Yes: No: ❑ <br /> MINOR: GENERAL:❑ MAJOR:❑ WA:❑ If answer is no-Please explain: <br /> Planning Project(SA,UP, MS etc.)Expiration date: <br /> a - Lot - _ 06 E <br /> MONTH DAY YEAR <br /> SPECIAL AREAS m"";` <br /> Subsidence Area:Yes: ❑ No: Expansive Soil Area: Yes: ❑ No: <br /> Fire Hazard Area:Yes: No: ❑ Airport Zone: 54bEi4rw Yes:X No: ❑ <br /> Enter rlse Zone. Yes. No: ❑ SJAFCA: Yes: ❑ No: <br /> ;. -, ,.. <br /> s; BUSINESS LICENSE -.4 <br /> Required: e,s U No L BL No.: - _ Fee Paid: Yes: ❑ No: ❑ <br /> COMMENTS <br /> Wo PA—Oak— D.36. <br /> Plan Check Only YES File# <br /> Technician: I Date: 21 3 OS <br /> F:1 IdiWWaM MN RMIT APP-GRTDING FB #12882�1PJ ) Page 2 of 2 <br />