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WHO MAY APPLY? _f <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 K this information is <br /> • A completed"Authorization for Application"forth if other than already on file with the Department) <br /> the owner applies • A waiver forth If the contractor is not subject to worker's <br /> compensation laws <br /> • A completed "Authorized to Sign" forth 9 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: APN: ZZ)- 0 <br /> Cross-Street: _ Cifly:. ZIFf: <br /> Precise Location: . GC U <br /> Wbdl Name: MaD# mow <br /> Zoning and Setbacks Zone: —�, Front Left: t Rear: Height <br /> School District Fire District: <br /> Sewer District: Water District: s <br /> Approved Use: <br /> Site Flan 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 /> 1 � I W <br /> MONTH DAY YEAR <br /> SPECIAL AREAS <br /> Subsidence Area:Yes: (3 No: <br /> No: E nsive Soil Area: Yes: No: ❑ <br /> Yes. <br /> 16'Hazard Area:YesNo: ❑ Airport Zone: Yes: No: ❑ <br /> Ente rise Zone: Yes: No: ❑ SJAFCA: Yes: ❑ No: <br /> BUSINESS LICENSE <br /> Required: Yes: ❑ No: ❑ No.: I Fee Yes: ❑ No: ❑ <br /> r <br /> COMMENTS <br /> D <br /> 2� L .7L <br /> G Z <br /> Plan Check On YE A File# <br /> Technician: Date: <br /> F:eu,n.m+«woviwn..r,r._ M4 w»ott Page 2 of 5 <br />