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1 CITY O: AMOND BAR DEPARTmENT OF COMMLJNITY�LOPME 6..dICES 21660 E Copley Drive Suite 190 (909)860.3195 Fax(909)B61•3117 PRESS ��^ BUII.DING PERMIT APPLICATION FIRMLY N JOBSITE � APPl1CATION PERMR � p/C o A�DRESS y3^�'b S DATE 3�1�F ��SC,NUMBER N � APN LOT�TRACT �� 'L7 ISSUE TYPE OCC DATE CONST. GROUP g OWNER S t1:1 e'P- ADDRESS Z3�i�l� • �• I ' ZONING SETBACKS �" cm'Dtn.wunu( P�an. ziP'tt�r �. o4-3db-�It�, ❑ FlEAR Rw e � APPLICANT __ TEL � SIDE/SIDESTAEE7 RW ❑ CANTAACTOR S�DE ❑ ADDRESS c� ' g CITY ZIP TEL PROPOSEDUSE�I�f�t�S{�lt,�In,�liC �K.rv�tnV ' Pu ARCHIENG/ ' `.'- - ��,, DESIGNER N0.DWEL' . NO. uyw, r � NO. y CDDRESS � ZIP TE4 UNRS STOR�ES BEDROOMS � m OESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION O OWNER•BUILDERDECUpATION ' SFRIADDA7EM BIHERFRI�fi�YM9ER�EY4TYDi�FM)MVTUTIWE1EYotiq0ulMECOUIpACipqg4 GfrtQ�T.�rrJR � GEMSFIAWfORTIFPOLLdYYqPEAtONB�C.]GI1.iN3NFW/MYROFF6t10MS000EWYGiYOX (n COU1lfVW1q111EW�RFS��lMIIf7OCON5T1K1Cf.lLTERY>ROVE.OEMOUMORREMIRNA'61RtIG W P/IW'OKk 111f1E.PRDNTORtaeUUu�CE.NlONEOUY1E67MEAIV�MNTFDqgt1CJ1IERYITTOi4E�Di0MED W �uIpYEM T4T XE OR 6NE 6 110EM5ED PURSUNli TO T1E PROV1510N5 OF THF CdHiMCf0111 LL � CENSE Uw 1�1MPTER�I�VE/'C�q W�iMlECTioN lmal Dc DIVIBd1�Oi iNElWIMEI M+0 Mq. � POOU�',tp� � FESSqNSWOE)ORIMATNEq15NEpFlIFYPTTMFRFFf104/NDTNEWiSiOPTNEALLEQEOFIfEYP. n �� « TiOx.YnVnUTdD�3EGIqNMOt.6EYINVYRKNRFd1�'E�wTEU61FRlTIEMVLIGWflO Z R►ROO} .i� � ACJLVEwuTtocror�cRElwNsrvEMtwUaFDoatARSP�Ik � �1A40IMFROiINEVRWFRTY.p1YYFlAOL01'FE9WfMWI.OFS65MERlIXFOOFNFNS1TtlN. ���� 1MLL DOIME W01YC AND TME ftRXTX1E 18 M0T MEMFD q10FFFRFO fOP iNE 18EC TW 9u6i� �J y MFl9IMPROiElBiWSfLOETffODHfMROWl10E1/SEUWD0E5WTNPLYTOMIOWNEROi � V ROPFiRI'MO BU�D6 pl��MOYE S TMF REdL NDVM DOf 6 SUOI MqRK NY6ELF OR I�ET6ELi Oq � TIIqOUpNMISORNFXO�wNFYVWYEFS,VROVIpEpTUTtUCNNWIOVFMEM9�RFNOTMiFNUED011 m OiTERmFOR S�LE IF.11pNEVF0.iMElIADM6 W N%10VFYEHT65plyNRMW pNEYFAHOiCOM0.F� Tb1.1ME OYMFNlU4DEN M41 IUVF iME BUROEN Oi PROYWO T1uT HE OR SME DO IqT GUIG OR YMIOVE fOR TNE NR/06E Of 6�1F1 � p1,A40MMEROFIMF�ROVfRl1'.N1FIf1USIVFLYfDNfMCTV10NTiMLICEN4E000HIMCip13 7ULON'iRUCTTIIEMID.lERf5EC.1Dw.lUlWESSMIOPPOiE5S10115W0E:TIECOHiRACTOHSt1� V�I��IId1 ADJ.AR� CE�6F Uw pDES MfM0.1T0�M ONNFR OCAPROnE0.M1YnqlUMS OR MMUtlES TIFREp4 J1ND � r�woarta�crsronwwnao�ccravnnumrtn�crows�Kswseoouneuurtron�emrrtaw OUAMTiY DESCFIPTION FEE TWS UCFN6F4W.). .J OIAIIIXEY WpEREE B.{Y.CFONMSREASON Q 3 �_,.�.�,1 �_. u � DATE n.•Z��Vtt7 Owr/EA � � LICENSE�CONTRACTORSDECURATION W � INFPEB�/.iiN11lMDER�EwLLTYOFPERlIMYMATIAYLCEHSEGUNOENORONSIONgpip4PTER � S �IGWWFNCNOWIfNSECIi01110W)OiDM3qNlO�TMEBUS�NE561iNDY1qiFSSi0H4[OOE.AIA Z � WLICENSE6MfULliONCEIwDEfFECf. m � LICENSECLA55 I�C.NO. j v DATF ,_CONTiuCiOR � , . L� 06 WORKERS'COMPENSATIONDECUMTION � yINEREBY/JfIR4VNpFR�EN.ILTYOCVERllMYONEDFTMEPotLOMVqOEQAMTIDNS: � ' , � _IM�Y'OMLLWNTUN�CENMCATF0�00N5ENTT0lEli.1N5VREiqiriWINERS = ODUPFNSrtpM.Il50ppVpEplY6EGlqHT000�T�El��ORC00E.iOR1NEPEPaD11YANCE W Q OFTIEWd+KFOFWMCMIMSYENMIT6i55VE0. � . 4 _IWWENqNnLL4AMAWWOPoIFRS'COMOFIISATIONINSUPANGE.A�RFpARfDlv6EttCN � /._ � nMOFiMEIABOROoOE,iqIT1EYFPfoRM�WCEOiINEwoRKFORvmiMMTn]oEN�RIS �% � 65UE0.WN01Y(ENSCO4o(119ATIp11NSM�MCEGNRIERNIOPoLICYlA14BENARE' CONSTHUCTIOIJ �G � � WINER PLANREVIEW 0 V0.KYMAMFR � ELECTHIC p (n6eK'Iv,NEIDwrBEm�nFTmoFTEPEp�nswnwErUffEDmIAM1sa+wloNlES1 PLUMBIN6 Z ICEIITIM1MRNTNEPEMFq1u�WCEOiMEMOMXFd1WMCNMSYERMR6155VF0.1 MECHANICAL � [�' . . 6�ULLIqTEMVLOVAM'GE0.5p�w.WiY/�ERSOASTOBECOUEfU61EttT0TNF N NOxKEMSCO�nEN4�ldUNSOFGWf01W1AM10�GNFETNAiF1E1qULDBECOME IN57EC710NFEE S 6UBIFRTOIXFNOM1tFR6'OO�OENS�TON�iqNSqNlOidFCTiOIf1mOFTHENBOR DODF,I 6iW1 iORMWTM W,.�CtY MM MOSF VROVISIOMS. ISSUANCE L w �,�P ����D00 � . o.�h: �vvteum. � WAMx�iAiLYRET�6ECUREVAN�ERS'OOM>ExS�TWGOVER�OEIltIM/w'FLl,1VOYu�LLlE ENERGYPIC � Su6�ECfIxE�RO�'ERTOCNue,.LL>EMµT�ESanOCMLfNESVVTOOMEMIMRE0TW5AM'1 EMERGYPERMIT FD1AM r 6�EC D5f MOF1NEtABORCOOE,NTECR�FST.INO�TTORNEY3FF S�n���•��EDFd1M � " " AerErmoN�E: 13[fILDING ANBSA�TY a CONSTRUCTIONLENDINOAGENCY PRE•ALTFEE: O � INEPElYIiflNUNqERYENKTYOFPE0.NRITIATTMEREB�WMSTRUCiqNIEHpN0A0EMCY FOR 1ME YERIORuu{E pi T�E N'ORK FOR YMIW Mtt IE WMf IS ISBUEOISEG.fM.CN.L� � � l[wOERSN.wE � LE�ERSI�oNE55 � IGEIiTFYTUTIIUVEREMMSMVLIGTDNNiDSTA1FTUTINFFWVFHLORMATWI500fWfCL TOTAL FEES � d IA6HEEtOCbAVL�WITMW.UfV/JOWUNiY011pYYMCE6YOST4TEUWEPElATNOT(1lUlDIHO I.. CONSTRUCiIdLM1pMERFYY�VI1qNiZERFi11E5ENi�TNF50iM5C0UNttTOFMFHUPONMf � MOJFJIFMTOMEDVPOOEIiTYiORNSnEttWYUNroSEi a couMenrts � S�t,�i o a. � PFRY1ITFEWW NIEN1) tn �-" 1 �..'��(-SCL�U y MON�NNEOFVE� MlE � � �cnr.r+o. v�uo er VALJDATION WH�TE—Dap�nmrit Copy,YELLOW—Fiuna Cory,RNK—Auuar Coq,GOIDENHOU—�FlN Caq,OREFJi�hppOrant�Copy . � , __ .. -- �--- �--1 -� `�t � �f wt-�. ��ti= • �