HomeMy WebLinkAbout16647 ' � ��' � CITY OF DIAMOND�AR ----�' --- DEPARTMENT OF COMMUNTI'Y�c DEVELOPMENT SERVICES ' � � � 21825 E.Capley Drive u �" (909)860-3195 Fax(909)861-3117 PRES$ � BUILDING PERMTT AP�LICATION FI RMLY a� JOBSITE ��"! �.��� L� �y�F DATE CATION � .�� , �� NUMB R � #/C ADDRESS J �P o ISSUE T`fPE OCC `r° APN LOT TRACT DATE CONST. GROUP p OWNER . 10�'� ��F� ��°l�-- LL ADDRE �- � ZONING SETBACKS o CITY�I/��'� � IP�,s TEL.��3?�� REORT _ RW ❑ a APPLIGANT TEL SIDE/SIDE STREET RW ❑ m CONTRAC70R II e�� SI�E ❑ a ADDRESS �.�.,�' " �'[/'Qi� S:� ,�/' �r�'� �" � � GITY �� � ZIP � +`3 TEL. ����"�P� PROPOSED USE o ARCH/ENG! ' w, DESIGNER � NO.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. 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RETENTIONFEE: .QJ% . � �� � ' �'_Sr_�..s�._....__.__.._ pW.�„ CONSTPUCTION LENDING AGENCY PRE-ALT FEE: � 4 I HEREBY AFFiPM LINDER PENALTY OF pERJURY THAT THERE IS A CONSTRUCTION LENOING AGENCV FOfl THE PERFOflMANGE OF?HE IiWORi<FOR WHICH THIS PEFMR IS ISSUEO(SEC,3oe�,CIV.C.), Z. ' W �. LENDER'S NAME F_�.�. LEN�ER'SA�DPESS y ¢�� . ICER71FY7HATIHAVEREADTHISAPP�ICATION STA7EhIATTHEABOVEINFORMATIONISCORRECT. TOTAL FEES ' �, �a�,6 � Q', ' I AGREE iO COMPIY WITH ALL CiTY AND COUNT DINANCES AN�STATE LAWS RELAiING TO BVIL0ING ' .� CONSTAU ANO REBYAUTHORIZE NTATIVESOFTHISCOUNTVTOEM7ERUPONTHE Z� ��ABOVE- NP� E OPERTYFORINSP CTI ' RPOSES. � Q,, � COMMENTS — – �, m�� ��, PERMITTEEN ¢' ' � -� B � � ' Uj ' SIGNATUREOF ERMITTEE DATE � _ ,f T RECPT.NO- PAID BY VALIDATION ~ � WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy -.,,. .':...:. . :.. ..:: .:,. -.,� '„ .._.'_':... �.,... . : . . . .:._..e, .,...:.�. ..-:--'� ,� 4. . . 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