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s. <br /> s. <br /> 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 compensa. <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 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: cf. tvi �t 12 t 9�� l'c r -7 Ul, t' Kef'_ APN: -0'-C) --3( <br /> Cross-Street: C <<lv r S 1 Cit : ZIP: <br /> Precise Location: ' a 5 t <br /> Subdivision Name: Map# BI/Lot# <br /> Zoning and Setbacks Zone: A- (-24; Front: 30 Left: -3v Right: 'O Rear: Height: -- <br /> School District: �;ckll . i1( f-I e Cf Fire District: %,iU�.p �'✓I C "� <br /> Sewer District: ✓ I V6�c'C.' Water District: o� <br /> Appro Use: 3 3ZS4 b(t r� lcet-et.% <br /> Site Plan Type Hazardous Materials Survey Submitted: Yes: ❑ No: ❑ <br /> MINOR:112( GENERAL:❑ MAJOR:❑ N/A:❑ If answer is no Please explain: " <br /> Planning Project(SA,UP, MS etc.)Expiration date: <br /> 19 ?( � S <br /> MoNtH DAY YEAR cam. <br /> SPECIAL AREAS <br /> Subsidence Area:Yes: ❑ No: ii, Expansive Soil Area: Yes: ❑ No: <br /> Fire Hazard Area:Yes: No: ❑ Airport Zone: Yes: ❑ No: <br /> Enterprise Zone: Yes: ❑ No• SJAFCA: Yes: ❑ No: <br /> BUSINESS LICENSE <br /> Required: Yes: ❑ No: ❑ BL No.: ~�''"`"' -----Fee Paid;-_._. Yes: ❑ No: ❑ <br /> COMMENTS <br /> :- ( <br /> _ _ Shly'_'�_ee eLt 0 <br /> - C tee. <br /> A oly� <br /> Plan Check Only, YES File# <br /> Technician: Date: <br /> F.6lNtDINGWANOpUTPERMIT APP-COUKERCIAL.VX Fib NQS(R-iwd 107602) Page 2 of 5 � <br />