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WHO MAY APPLY 7 <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 workers compensation <br /> • A completed and signed"Owner-Builder Verification"form insurance certification (this is riot 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 workers <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: 1 'J 1 h Q� p� APN: <br /> Cross-Street: of p v C . G h ZIP: <br /> Precise Location: Q- 8.rJ G h L/ <br /> I up <br /> Subdivision Name: Ma �— BIILot# <br /> Zoning and Setbacks Zone: p Front p Left: ht: Rear: J ht: <br /> School District U I I G Fire District: 6r 1d c ' et G- <br /> Sewer District: f t J Water District: r, <br /> Approved Use: u <br /> / Site Plan Type Hazardous Materials Survey Submitted: Yes: No: ❑ <br /> INOR:19 GENERAL:❑ MAJOR:❑ WA❑ If answer is no-Please explain: <br /> Planning Pro ct(SA,UP, MS etc.)Expiration date: <br /> ) a „2UU7 <br /> MONTH DAY YEAR <br /> SPECIAL AREAS <br /> Subsidence Area:Yes: ❑ No: I� Expansive Soil Area: Yes: No: ❑ <br /> Fire Hazard Area:Yes: tf No: ❑ _ Airport Zone: Yes: ❑ No: d <br /> Enterprise Zone: Yes: ❑ No: d SJAFCA: Yes: Z No: ❑ <br /> BUSINESS LICENSE - <br /> Required: Yes: ❑ No: ❑ BL No.: Yes: ❑ No: ❑ <br /> COMMENTS <br /> t (►` Lh f 5 <br /> — 11 1¢ ilS ¢ t. c t p i ¢S <br /> p e — p S -(Z-g<" <br /> i P'D C- _ ID <br /> Z.oN� +3 <br /> Plan Check 10 ZA C_ Fka 6 <br /> Technician: Cl Z Z <br /> • .rnawwre Page 2 of 5 <br />