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WHO MAY APPLY? <br /> ONLY THE OWNER OF THE PROPERTY OR A LICENSED CONTRACTOR MAY TAKE OUT BUILDING PERMIT <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 compens. <br /> • A completed and signed"Owner-Builder Verification"form insurance certification(this is not necessary if this information, <br /> • A completed"At4horization 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 /> • 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: 6 Q APN: cr-13 C) - <br /> Cross-Street: 5C � f Ci 7- ZIP: 3-7 <br /> Precise Location: 12,nG 2 /of S I c�G �+ $-ocx) 4.4 So L, ' <br /> IAI . 6-./ t <br /> Subdivision Name: Map# BULot# <br /> Zoning and Setbacks Zone: _L rant p Left`, C� Ri ht: 0 Rear: 0 Height: <br /> School District: �` .:,r L <br /> I J�'/ Fire District: / �� k G? Z <br /> Sewer District: V =' Water District: // <br /> Approved Use: V f <br /> Site Plan Type Hazardous Materials Survey Submitted: Yes: ' No: ❑ <br /> MINOR GENERAL:❑ MAJOR:❑ N/A:❑ If answer is no-Please explain: <br /> Planning Project(SA,UP, MS etc.)Expiration date: <br /> 2-- i�r a& <br /> MONTH DAY YEW <br /> SPECIAL AREAS <br /> Subsidence Area:Yes: ❑ No. Expansive Soil Area: Yes: No: ❑ <br /> Fire Hazard Area:Yes: No: ❑ Airport Zone: Yes: ❑ No. <br /> Ente rise Zone: Yes: ❑ No: SJAFCA: Yes: ❑ No: <br /> BUSINESS LICENSE <br /> Required: Yes: ❑ No: ❑ BL No.: Fee Paid: Yes: ❑ No: ❑ <br /> COMMENTS <br /> COLZP o. <br /> P e- G <br /> Plan Check Only YES / File# <br /> Technician: Date: —Z <br /> F:su—cvu-=WEftW Am-0M"RCLAL.DM FM ries(R~10.30,Ml Page 2 of 5 <br />