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WHO MAY APPLY? J <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 if 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 form if the contractor is not subject to worker's <br /> compensation laws <br /> • A completed "Authorized to Sign" forth 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: 7 1 S ST 1~T �Y—,f _ APNIA <br /> Cross-Street. city., �fcx k � ZIP: X5215 <br /> Precise Location: 6fl 4;?jF e—� <br /> Subdivision Name: Map# BI/Lot# <br /> Zoning and Setbacks Zone: I— L Front: Left: ✓1G� R' ht ht i [i <br /> School District' � Fire District: lY L>rY 1 <br /> Sewer Water District kZ=� <br /> Quad Use: <br /> Site Plan Type Hazardous Materials Survey Submitted: Yes: No: ❑ <br /> MINOR:W� GENERAL:❑ MAJOR:❑ WA:❑ If answer is no-Please explain: <br /> Planning Project(SA,UP, MS etc.)Expiratioondate: <br /> F5 � �2 1 <br /> MONTH DAY YEAR <br /> SPECIAL AREAS <br /> Subsidence Area:Yes: ❑ No: Expansive Soil Area: Yes: No: ❑ <br /> Fire Hazard Area:Yes: ❑ No:V Airport Zone: Yes: No: ❑ <br /> Enterprise Zone: Yes: bV No: ❑ SJAFCA: Yes: No: ❑ <br /> BUSINESS LICENSE <br /> Required: _ Yes: No: ❑ BL No.: Fee Paid: Yes: ❑ No:Jan <br /> COMMENTS <br /> Plan Check O S — F <br /> kO 94 <br /> Technician: - - -- Data: <br /> F.'axowcvwaa+rs m wewm -COMMS %LFh•tzsd. Page 2 of 5 <br />