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WHO MAY APPLY ? ONLY THE OWNER OF THE PROPERTY OR A LICENSED CONTRACTOR MAY TAKE OUT BUILDING PERMITS.. Owner -Builder must submit the following with the application: • A property tax statement or a recorded deed • A completed and signed "Owner -Builder Verification" form • A completed "Authorization for Application" form if other than the owner applies Contractor must submit the following with the application: • Current license numbers and a worker's compensation insurance certification (this is not necessary if this information is already on file with the Department) • A waiver form if the contractor is not subject to worker's compensation laws • A completed "Authorized to Sign" form if other than the contractor applies (this is not necessary if this information is already on file with the Department) THIS PAGE TO BE FILLED OUT BY DEVELOPMENT SERVICES STAFF PROPERTY INFORMATION Job -Site Address: . �4 (; a ,� APN:15_3 - - Cross -Street: Ci : ZIP: Precise Location: 6 i1 S i t O; G (; 4. Subdivision Name: --- Map# BI/Lot# Zoning and Setbacks Zone: IQ& v Left: I L) Right to Rear: Hei ht: School District: l So VN Fire District:a Sewer District: Water District w4v App roved Use: t U, ,i Site Plan Type / MINOR: ❑ GENERAL: ❑ MAJOR: ❑ N/A: Fd Hazardous Materials Survey Submitted: Yes: ❑ No: Q-' If answer is no -Please explain: Planning Project (SA, UP�MS etc.) Expiration date: MONTH DAY YEAR SPECIAL AREAS 71 Subsidence Area: Yes: ❑ No: t' Expansive Soil Area: Yes: ❑ No: ,G' Fire Hazard Area: Yes: ❑ No: AEr Airport Zone: Yes: kf- No: ❑ Enterprise Zone: Yes: ❑ No: ❑ SJAFCA: Yes: ❑ No: BUSINESS LICENSE Required: Yes: ❑ No: ❑ BL No.: aid: Yes: ❑ No: ❑ COMMENTS �2 Plan Check Only YES File# Technician: Date: 64 r'.*W IL INWHANDOUTSARCHIVE PRIOR TO20W8\PERMITAPP -COMMERCIAL He8125.dw Nage 2 of 5 }