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WHO MAY APPLY 7 <br /> F�vn <br /> ONLY THE OWNER OF THE PROPERTY OR A LICENSED CONTRACTOR MAY TAKE OUT BUILD ING PERMITS.. <br /> er 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 /> :e 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: w�c n n�-r_ APN: Z 3 -- )YO - 03 <br /> Cross-Street: ftvn -v P_('Ie/ City: Tyq. ZIP: <br /> Precise Location: <br /> r <br /> a 4. <br /> Subdivision Name:. Ma e--: BI/Lot# <br /> Zoning and Setbacks Zone: -LID Front: Leff; Right:._ cv Rear: Hei ht: lY <br /> School District: 644 Fire District: <br /> Sewer District: Water District: <br /> ApprovedUse: <br /> Site Plan Type Hazardous Materials Survey Submitted:-Yes: No: ❑ <br /> MINOR:❑ G NERAL:U . MAJOR:Ll N/A: If answer is no-Please explain: <br /> Planning Proj ct(SA,UP, MS etc.)Expiration date: <br /> MONfH DAY YEAR <br /> SPECIAL AREAS <br /> Subsid ce Area.Yes: ❑ No: Expansive Soil Area: Yes: ❑ No. <br /> Fire H rd Area:Yes:`U No: Ai art Zone: Yes: ❑ No: <br /> Ente rise Zone: Yes: ❑ o' SJAFCA: Yes: ❑ No: <br /> BUSINESS LICENSE <br /> i <br /> Re Ered: Yes: ❑ No: BL No.: Fee Paid: Yes: ❑ No: ❑ <br /> COMMENTS ZvNE Ata CFL Z <br /> a73Si3 <br /> -7/44313 <br /> i <br /> Plan Check OnIA YES File# <br /> Technician: Date: <br /> 7?_1LDIN3YUINDOUTS ARCHIVE PRIOR TO 2DD&PERMIT APP•COMMERCIAL Fie#'t25.Eoc Page 2 of 5 - <br /> k��- <br />