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HomeMy WebLinkAbout17120 �` CITY OF DIAMOND BAR � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Coptey Drivo ' (909)860-3195 Fax(909)861-3117 PRESS `�� BUILDING PERMIT APPLICATION FIRMLY o DDR'E5S�36I� !�C d(LA� DATECATIDN � t� DI NUMBER �� ( 20 q��� � ISSUE TYPE OCC APN LOT TRACT D p OWNER (�� DATE � CONST. GROUP � AODRESS.�i��� �' j3 ZONING SETBACKS z CIN �� ZIP � TEL.Qt��/ D S�)f FRONT RW ❑ o APPLICANT r • o.�' TEL. REAR p SIDFJSIDE STREET RW ❑ Q CONTRACTOR �P Co SIDE ❑ ADDR SS � CITY r ZIP � TEL. 7 • PROPOSED USE o ARCHIE / /�s*S z DESIGNER w N0.DWEL. NO. NO. a. ADORESS � CITY ZIP TEL. UNITS STORIES BEDROOMS � � DESCFiIPTION SO.FT. 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'� RETENTION FEE: i a CONSTRUCTION IENDING AGENCY ��� PRE-ALT FEE: O � IMEREBVAFFIflMUNDERVENALT/OFPERIURYTHATTNER[ISACANSTRUCTIONLENDINGAGENCY � FOR TME PEFFORMAVCE OF iNE WOPK FORKNIGM THIS PERMIT IS ISSUEO(SE:..9oi1,CIV.C.). W � LENDER'S NM1E � LEN�ER'SADONESS � TOTAL FEES �•�j1� - W 1 CERTIFV 7MAT I IUYE REI�TNIS AFVUCATION AN�STATE THATTHE�BOVE WFORAIATpN IS CORRECT. p_ I�GREETOCO/APLYWITHALLCITVMI�COUNTYOitD64ANCE5AND5T�TEUWSREUTIHGTO8UIL01NG � CANSTRUCTION,ANOHEHFBVAUTHORIZEREFRESfN:ATNE50FTHISCOUNTYTOENTEHUPONTHE Z ABOVE�IAEN710NEDVROPERTYFORt 57ECTIONPURDOSES. � COMMENTS o .��c. ..I ` Q PERu1TTEE N � T) � � 4 / E'7 � I URE ENMITTEE OATE � RECPT.NO. _PAID BY VALIDATION WMITE—Department Copy,YELLOW—Finance Copy,PINK—Assessar Copy,GOLDENROD--Fi�e Copy,GREEN—Applicant's Copy . . .. . . . ... • , ,. ._' . 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