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HomeMy WebLinkAbout16183 CITY 4F DIANfJND 8AR � - ``�' DEPARTMEr'P OF COMMUNITY&DEVBLOPMENT SERVICBS ' Z�s6o E.c�y nriVe s��i90 pRESS (9p9)860-3t95 Fu(909)861-3117 � L}/ 'm�^"�' giTII,IfiNG pERMTT APPLIGATION � JOBSITE �� APPIICATtON�� f� PERMiT �� ��C o ADDRESS d DATE �� NUMBER r k � 185UE /� TYPE OCC APN LOT TRACT-T pATE t/ CONST. GROUP p OWNER ��� ��-�,�'if2f✓._ S.' � p ADDR@SS � ZONING SETBACKS � CITY Z1P TEL. �� FRONT RW ❑ APPLICAN7 TEL �`�]�`7 r'7 REAR G � �-^--z�-=-r- SIOE/SiQESTREE7' RW Cl CON7RACTOFj SI�E C7 g CITY�SS ZtP 7EL. PROP05E�USE � f � � ARCH/ENG/ � � --�t����� QESIGNER NO.OWEL. NO. -����).���_-- AD�RESS UNITS STORfES BEDROOMS � C1TY zIP TEL � y OESCRIP710N S0.FT. FACTOR PSF AOJ.AREANALUk720N p� OWNER-BUtLDER OECtAf1ATION SFRfADD1REM O p 1 NEPEBV AFFfqM UNDER PENALTY OF PEf WRY�NAi 1 NA E%EMGT FROM`,HE CONTRACTORs L�� GafBJBlCefport ill CENSEtAWWRTHEFOLlOW1NRRES90N�5EC.>p31.5BUSINF55MlOPROFESSIDhiSC��E:ANYCfTYOF (n _ �J OOUMYINiItliRfpNRESAPEAMITTOCON5TAt1C[,ALTER,IMPaOv�OEMOIISH,ORPEPFIFlANYSTPUC, 7JJ palio/Deck Z NFE,PflpR 71J ITS�SSV�V/CE.AlSO REGUIqES iHE APPLIGANf FOR SU(n FF.RM�T TO FiIE A SiGNEO �� BTATEMHJT THI�T HE�R SHE IS IICEMSE�PURSUANT TO THE GNOVIolONS OF TNE�NTMCTOF9 LI� W CEN$EWN(QUPTEAOiGOMMENCIW�WITHSECifONlWO)OiO1V13IW490FTt1EBUSINE530.NDPA0. �' POOUSAd FESSIONS COL1E�OR THAT HE OF SHE IS EXEMPTTHEREFROM AND h1EBP5i5 FON TFIE AClEO[0 E%�MG� TqN,ANYVKKAiqMOFSECT10N�001.5BYANYqPPIiCI,NTFOPAPEPMITs�1HJEC'STNEAVPLICAMiO � A2-R00� � M AGV1tPENALIYOFNOTMDpETHANFIYEMUNORED00LUR5(i5W)): � ❑t�SONMEflOFTHEAPOPEii'(Y,OPi.IYEMPIpVEESWISHW0.6£SASME{k50l.ECAMGENSAtION, Q Commeroia� � WILL 00 THE WOqK,FND THf SiNUCiURE IS NOT IN?ENDED Ofl OFxERf�FpR SAIG(SEC.�Ou,8;151- _J y qE85 MJO PNpFE55pN5 WOE:THE�NTARCTOqS LICENS6 LAW OOE5 N01 APP Y TO AN OWNEH OF � P(i0PE0.TYNM1lOBWLOS OR WPPOYESTHE0.EON,HND WHOOOES SUCH WORKHIMSEI.F OR HERSELF DF ('t 1'nRIXf(NINISOHttEFlOriIJEMR.OYEfS.VPDVI�FOTH0.iSUCHIMPPOVEAIEN�SAqENOTINTENOEDOfl � � OFFEf�1FORSN,E.IF,HOWEYEiL1NE8U�lDiNGOflIMPROYEMENi15501'JWITHINpNEYFAPOFCOMpIE� �TkX.,7HE OWNE0.AUhGEF 5WLL HAVE 7NE 6UROEN OF pROVING THAT HE o0.SNE tllb NOT Bt1LL➢OR � RAFiIOYEfONT*iEPUAPOSEOFSµE;. 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