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WHO MAY APPLY Z <br /> ONLY THE OWNER OF THE Mc PERTY OR A LICENSED CONTRACTOR MAY TAKE OUT BUILDING PERMITS.. <br /> Owner-Builder must submit the following with the application: ,, C,Pntpctor 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'form if other than 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 /> G �- ��� • A completed "Authorized to Sign" form 9 other than the <br /> contractor applies (this is not necessary if this Information is <br /> already on file with the Department) <br /> ! THIS,PAOE TO BE FILLED OUT BY DEVELOPMENT SERVICES STAFF <br /> PROPERTY INFORMATION <br /> JobAddress: ��.� APN: <br /> -Site <br /> Cross-Street &2 1 city: r✓ti ZIP: Q <br /> Precise W n: IT2 <br /> Subdivision Name: map# BULot# <br /> Zoning and Setbacks I Zone: _6 Front Left:i Rl ht: Rear:110YLkI Height: <br /> School District I <br /> __ Fire District: <br /> Sewer District 4q Water District: <br /> Approved Use: <br /> Site Plan Type Hazardous Materials Survey Submitted: Yes: fit/ No: 0 <br /> MINOR:O G :0 OR:❑ WA: If answer is no-Pkme explain: <br /> Planning Project(SA,UP, MS tc.)Expiration date: <br /> MONTH DA YEAR <br /> SPECIAL AREAS <br /> Subsidence Area:Yes: 0 No: Expensive Soil Area: Yes: D No: <br /> Fire Hazard Area:Yes: O No: Ajfport Zone: Yes: O No: <br /> Enterprise Zone: Yes: O No: SJAFCA: Yes: O No: <br /> BUSINESS LICENSE <br /> Required: Yes: No: ❑ BL No.: Fee Paid: Yes: 0 No: <br /> COMMENTS <br /> Plan Check On S I _ Elle# <br /> Technician: Data: 2 <br /> r: _ ntm. poplin at~10,V- ) Page 2 of 5 <br />