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Home My WebLink About065-171-01265-171-12 John W. Curtis NIS Tikker Ln.,app. 270'W.of Wood Dr., it Haven Sub, Paradise 'PeWORTSTRUCTURE -76P,E(ut�l'.,MH) _ EI GAffSUREQ, ?� OMPA TION TESTQ . AP 65-171-12. Permit 4375-77MHI ISSUED val ill /1 1 (0 x17'7 7, K Ke r (.one, i►'�aR a I r CSI I.t'� �, �1�� "� . �� ;,. PERNT NO. 5022-76P; E PERMIT EXPIRES OWNER John W. Curtis CONTR. owner LOCATION (A.P. 65-171-12 NIS Tikker Ln.,(pri.rd'.),_app.270'W.offIIood . Dr., Paradise c, y Y 3 Temp. Power Pole Called PG&E Temp. Elec. Serv.— 3 % Called P'6&E 31 Temp. Gas Serv. Called PG&E ' JOB FINALED (Date) (Signature COUNTY OF BUTTE DEPAR'.ANENT OF PUBLIC WORKS 7 COUNTY CENTER DRIVE OROVILLS, CALIF. - 534-4541 CERTIFICATE OF OCCUPANCY This mobilehome has been installed in accordance with the requirements of the California Administrative Code, Title 25, Chapter 51 under permit number =i(- P for the following location: t Owner Q, Owner's A Mobilehome Mfg. Model Year ) Insignia No. *47 </ DR- / 10 Serial No. '3 O 3 y It is hereby certified for occupancy at the above described location and may be occupied. Director' of Public Works Date k 3 l- 7 By � 1 THIS CERTIFICATE IS VOID WHEN MOBILEHOME IS RELOCATED • COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS BUILDING INSPECTION RECORD Final BUILDING BUILDING (Cont'd) PLUMBING Setback Firewall Soil Piping Forms Parapets 1st Floor Main Bldg. Restroom Finish 2nd Floor Footings Windows 3rd Floor Stemwall Siding To out Slab Roof Sheathing Water Piping z/ i Piers Roofing Sewer. Garage Fdn. Vents Fixtures Footings StemwaI I Garage Vents Insulation Water Htr. Heaters Slab Carport Footings Prov. for physically handica ped Conformance of ex. structure Appliances Gas Piping & Test - 1 -'7 Temp. Gas Tv Slab Final Sanitation Patio FIREPLACE Final Footings F ooting ELECTRICAL Masonry Walls Throat Rough Reinf. Steel Final Fixtures Bond Beam FIRE SPRINKLERS Motors Scratch Brown Finish Interior Lath Door Closer DA TE Test Water Htr. Final Subpanels MECHANICAL Grd. Fault Prot. Heating Service rwM.::i2,1- Cooling Temp. Pole Ducts Under round F Z Ventilation Permanent Final Final REMARKS OR CORRECTIONS )�2)� (NOTE: An entry must be made on this form each time you visit the job site.) -M0B1:! f1J0:1G INSTAI.,LA ION INSPECTION CHECK LIST 1. Is the mobilehome located 1,7i.01 required separation from lot lines and buildings and generally conform to plot plan? Yc;; i/ No 2, Does the mobilehome have. required clearances above ground? (Sec.5085) Yes V No . 3. Are foot:in,s and supports properly sized, spaced, and braced as per approved plans? (Note possible variation at spring shackles.) (Sec. 5082 & 5083) Yes 1/ No 4. Is the mobilehome level-? (Sec. 5088) Yes / No 5. If more than a single unit, are crossover connections properly installed? (Sec..5088) Yes No 5. Water A. Is flexible connector'�of adequate size -and properly installed (1'/2" ID min.)? (Sec. 5566) Yes t//No B. Test - Does water piping withstand working pressure or 50 lbs, air test? Yes ~", No C. Backflow - If coach is not State of California approved, does station have backflow device and pressure -relief valve?. Yes No 7. Wastes and Drains A. Is connection made with Schedule'40 DWV and have flex connectors at each end? -Yes " No B. Does it have minimum per foot slope and is it properly supported? Yes —"No C. Are.any leaks detected in drainage system after running 3 --gallons of water through each fixture including washing machine standpipe? Yes No 4; D. If coach is not. State of California approved, does station have required trap and vent? Yes No 8. Gas Piping and Gas Vents A. 'Connector - Is mobilehome connected to the gas supply with an approved 3/4" minimum mobilehome connector not more than 6 ft, long? Note: All'pi.ping is to be at least as large as the mobilehome gas'line inlet without reductions other than the mobilehome connector. Yes Z No t B. Test OK as per following procedure? Yes V"'No 1. Open all appliance connector valves. 2. Shut off appliance burner and pilot valves. 3, Air test with manometer to 10"-14" water column, or test with slope gauge (minimum 6oz.-maximum 8 oz.) calibrated in tenth .pound increments. Test for 10 min: without drop. 4. Connect: gas meter to mobilehome with connector, turn. on gas, test connections with soapy water. C. Are all appliance vents properly installed? Yes 4 --"No 9. Electrical A Is service large enoiigl. to provide adequate amperage to mc?bilolrome (must equal rating of nu,bi.lehome with a-.-in.ii^um of 100 amp) and other faciliti_C." on lot, i.e. , water pumps, Zarage, cabana, oto.? Yes t/ No B. Is them proper clearances around panels? Yes // No C. Is power supply cord or feeder assembly properly fused? Yeses No_ D. Is continuity test satisfactory as per the following procedure.? Yes �No_ 1. Ile -energize electrical wiring system of the mobilehome at the pedestal. 2. Plaice sure that the power supply cord or feeder assembly conductors, including neutral conductor, have been disconnected, 3. Switch all breakers and switches in the mobilehome to the "on" position. 4. Connect one lead of a test instrument to the mobilehome grounding conductor and ap�it�r tare Oi li.ei 13luaCs %U taUll iOUD...LCllUllle J'llp )1 CUIIulictU'r, , 1nCliiulilg item Ydl. 5. All nor. -current, carrying metal parts of the mobilehome (aluminum siding, gas line, water line), including fixtures and appliances, shall be tested for continuity from such equipment and the grounding conductor. 6. Upon completion of the above procedure, the power supply cord or feeder assembly conductors shall be connected to the site service equipment. A further continuity te..;U shall then be made between the grounding electrode and the chassis of the Mobilehome. UDOn satisfactory completion of theelectrical tests, the lot or site service equipment- may be approved for energizing. ;.r?. Is ;ob card si;n(:d by health Department for water and sanitation? 1.;.. If everything olray, sign off card and ta; services. MOBILEilO!^E_DATA manufacturer and/or Namestyle .ength (p 3 Width % Y Vehicle Serial No. State Identification No. 1). 40 4dei .L t ional Infoz na t: i on or Comments: SII •- '' COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 Telephone: 534=4541 APPLICATION AND PERMIT NOW autt(urlce representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. _ ate Signature ooff Pieerrmii7tee or Ag-ennt' eceipt No. ` J 0C White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR OF P LIC WORKS By DatePiZJ - 77 Build� Building permit expires Datey� ' � BUILDING Owner h C U it / C S SQ. FT. OCC. BUILDING VALUA ION Mailing Address ( 19q� 1 C 0d4 b Z Telephone No. OA/e—• Fireplace Contractor Total Valuation Mailing Address Permit Fee Plan Checking Fee &/or Penalty Telephone No. Permit Fee $ g LN(ion1Y41-E /��PLUMBING Buildin Address/G No. @ FEE PERMIT FILING FEE $3.00 DF 4(40e) C/ Each Trap 1.50 uNRepair drainage or vent piping 1.50 Water piping 1.50 Each gas water heater or vent 1.50 d., Z_ A. P. No. �r- !�� Zoning & Planning Gas piping system 1 - 5 outlets 1.50 r Each additional outlet .30 es ti' W.C. Fire Dept. Fire Zone Use Permit Building sewer 5.00 EQA Parking Plans Parcel Declaration D Parcel - P 60' R/W Im prove ents Lawn sprinkler system 2.00 Bldg. Plans Recd Parcel Approval Plans Approval Permit Fee $ $ NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER 2Q ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 OR L Main service i°o°o AMP ORSLESS 5.00 Main service EA. ADD'L too AMP 2.50 Single Family ❑ Duplex ❑ Mobil Home Q Others ❑ Main service R 600V 1100EAMP OR LESS 25.00 Main service EA. ADD'L too AMP 1.00 NEW OR ADDNST ( ACCLBLDGS.LING CCUP. &) 2¢.sgft NEW CONSTR. MULTI -OUTLET NON-RESID. (BRANCH CIRCUITS) 2.50ea NEW CONSTR. (POWER APPARATUS & NON-RESID. SINGLE OUTLET CIR. CONTRACTORS LICENSE LAW I am licensed under the provisions of Chapter 9, Div. 3, of the State of California Business & Professions Code under the name style of: Ex. Occup(OUTLETS OR FIXTURES) BAL2/ Ex. Occu FIXED APPLNS. OR P• 2.00 OUTLETS (RESID.) EA) Temporary service 10.00 Mobile Home Facilities 15.00 License No. Classification Misc. Wiring 6.25 R<am exempt from the Contractors License Laws of the State of California. Permit Fee $ $ WORKMEN'S COMPENSATION INSURANCE 1 am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability for Workmen's Compensation. ❑I have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to the Workmen's Compensation Laws of California. MECHANICAL No. @ FEE PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 2.00 Permit Fee % $ $ I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby 30 TOTAL PERMIT FEE $ Q autt(urlce representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. _ ate Signature ooff Pieerrmii7tee or Ag-ennt' eceipt No. ` J 0C White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR OF P LIC WORKS By DatePiZJ - 77 Build� Building permit expires Datey� ' � 1. 2. 3. 4. BUTTE COUNTY DEPARTMENT OF PUBLIC WORKS 7 County Center Drive, Oroville, CA. PHONE: 534-4541 MOBILEHOME INSTALLATION SHEET owner's name: �--r--iQ Installer's name: Is the site currently under permit? Yes : No (If yes, furnish permit number ) OR Is'the site an existing site? Yes / / No /? / (If yes, furnish two (2) plot plans.) Will the mobilehome be located at least 5 ft. away from septic tank and leach.fields and clear of all setbacks and easements? Yes No ( If no, clarify ) 5. What•is the mobilehome electrical rating? ----------------------- Am s -,, P 6. What is the mobilehome site service rating? --------------------- /j(D 'Amps 7. What is the mobilehome site circuit --breaker rating?-------------- `� r Amps 8. Is there any other electric load to be served by the mobilehome 9. 10. 11. 12. site service? --------------------------------------------------- Yes / / No./ P� (If yes, identify the load and size: (Load) (Amps) a ) What is the mobilehome site ga§=pipe ize?---------------------- in. What is the type of gas service? ------------------------------ -Natural / / LPG /! What is the gas pipe length from meter or tank to the mobilehome? �o _(ft.) What is the mobilehome gas demand? ---------------------------- .(BTU) (This information not required if pipe length less than 6.ft. on natural gas or less than,50 ft. on LPG.) I MOBILEHOME SUPPORT DATA Mobilehome Mfr. FI F_ --r w oe) Setup Model No. FC Year /70 Width C �— (ft.) Length. (ft.). - Expando Size ft.x — ft. (Draw support details below) On all mobilehomes manufactured after October 7, 1973, furnish manufacturer's installation manual and structural setup sheets (if not.on .file with.the County of Butte). le *If center piers are other than drawn above, draw in locations, spacing, and dimensions. Footings-(check.-one) 1. Wood.either pressure treated or fdn. grade. 2. Concrete pad. 3. Other,: specify Supports (check one) 1. Concrete block 2. Concrete piers 3. Steel piers 4. Other, specify Typical Support Footing Size Max. Pier Spacing Y Max. Overhang ......_. _ ink BlI'fTE COUNTY BUILDING DEPARTMENT APPROVED `COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS 7 County Center Drive — Oroville, California 95965 Tel ephgne: 534=4541 APPLICATION AND PERMIT authorize representatives or the county of Butte to enter upon the above-mentioned property for inspection purposes. . - r,)-- P, � ate Signature of Permitee or Agent Receipt No. /5-0,10 z3 White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR OF, -PUBLIC WORKS By— B v cDate�1— % % Ina 7?pireDateild BUILDING Owner V�� SQ. FT. OCC. BUILDING VALUATION Mailing Address [Vpq N Low• 9,4c. Q' Telephone No. Fireplace Contractor e5tkjIF—AL • Total Valuation Mailing Address Permit Fee Plan Checking Fee &/or Penalty Telephone No. Permit Fee $ ,p Building Address AWS 11!C 0— Pi�t�%�1�T��oA PLUMBING No. @ FEE PERMIT FILING FEE $3.00 , t� t ` pr KlOD oL /` o Each Trap 1.50 Repair drainage or vent piping 1.50 Water piping 4,5Q Q 6V A. P. No. �ps' „ -- Z "i" & " Each gas water heater or vent 1.50 as piping system 1 - 5 outlets5F1 Each additional outlet .30 Fees W. C. S i on Fire Dept. Fire Zone Use Permit Building sewer Q. (� EQA Parking Plans I ParcelLawn Declaration arce M p 60' R/W Improvements sprinkler system 2.00 Bldg. Plans Recd RRf 7 arcel Approval Plans Appro I Permit Fee $ 3 60 $ 3 3 ` NEW ❑ ADDITION ❑ UTILITIES ® OTHER ❑ ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 -eD Main service ;000V OR 0 AMP ORLESS5.00 V Main service EA. ADD'L 100 AMP 2.50 Single Family ❑ Duplex ❑ Mobil Home Others ❑ Main service OVER 600V 100 AMP OR LESS 25.00 Main service/ EA. ADD'L 100 AMP 1.00 • MINIMUM FOR MOBILES NEW CONST.OR ADDNS. \ ACCDWELBLDGLING OCCUP. &) 2�sgft NEW CONSTR. MULTI -OUTLET NON.RESID, BRANCH CIRCUITS) 12.50ea NEW CONSTR. (POWER APPARATUS & NON•RESID. SINGLE OUTLET CIR. CONTRACTORS LICENSE LAW I am licensed under the provisions of Chapter 9, Div. 3, of the State of California Business & Professions Code under the name st Ya of: Ex. Occup(OUTLETS OR FIXTURES) BAL@1 FIXED APP LNS, OR EX. OCCUp. OUTLETS (RESI D.) EA) 2•00 Temporary service 10.00 Mobile Home Facilities 15.00 S;00 License No. Classification Misc. Wiring 6.25 am exempt from the Contractors License Laws of the State of California. Permit Fee $ Z31156 $ 01b WORKMEN'S COMPENSATION INSURANCE 1 am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability for Workmen's Compensation. ❑I have placed on file with the County of Butte a certificate of Wo en's Compensation Insurance. L!Jlcertify that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the Workmen's Compensation Laws of California. MECHANICAL No. @ FEE PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 2.00 Permit Fee $ $ 1 certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby TOTAL PERMIT FEE $ OC authorize representatives or the county of Butte to enter upon the above-mentioned property for inspection purposes. . - r,)-- P, � ate Signature of Permitee or Agent Receipt No. /5-0,10 z3 White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR OF, -PUBLIC WORKS By— B v cDate�1— % % Ina 7?pireDateild This set ofIons and specifications MUST I e kept on the ioat all times and it is unlawful to mry!•P e,nv ckro„nes or rltercrtions on some without written permissionfrom �ehe Department of Public Works, County o NOTE:—All Materials A Workmanship Shall Be in Accord' rice with Recognized Good 'Prmctices and of a quality prescrihed for ' the Spec' -f -ed use in the Uniform Building, Plumbing & Machanical Codes the National Electrical _Code. Ceptic system arrd location aag—d�aiub to be as per ®�� '� hall be 5 ft• frons Butte CountyHealth Dept. Re- Setback s .quirements. p lop roperty line and So t #mg fc.,� c6�terl+ne of the rood, overhang. n nsaXi"'�tEr9't of a 2 ft. i t 07 All utility connections shall be located within 4 ft. outside the rear third section of the mobile home on the left (road) side of -the mobile home. BUTTE COUNTY BUILDING DEPARTMENT APPRO)/ED BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION (IVR): (530) 538-4365 OFFICE: (530) 538-7541 FAX#: (530) 538-2140 ONLINE PERMIT/RENEWAL PAYMENTS: www.buttecounty.net\dds Site Address: 6477 TIKKER LANE APN: 065-171-012 Permit type: MISCELLANEOUS Subtype: Electric Panel Description: NEW ELECTRIC SERVICE HAMBLETON WILLIAM ELECTRIC P O BOX 189 STIRLING CITY, CA 95978 (530)873-6039 PROJECT INFORMATION Owner: CURTIS FAYE F. P O BOX 544 MAGALIA, CA 95954 (530)873-0165 HAMBLETON WILLIAM ELE P O BOX 189 STIRLING CITY, CA 95978 (530)873-6039 FEE INFORMATION DBE Single Phase Service-Resid $59.00 LICENSED CONTRACTOR'S DECLARATION Contractor (Name) State Contractors License No. / Class / Expires HAMBLETON WILLIAM ELECTI 869626 / C10 / 12/31/2009 I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am licensed under provisions of Chapter (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force an ed. X �%` r 12/17/2008 Contractors Signature Date WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations: ❑I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑I HAVE AND WILL MAINTAIN WORKER'S COMPENSATION INSURANCE, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Workers' Compensation insurance carrier and policy number are; R Carrier. Policy Number: Exp. (This section need not be competed if the permit is or one hundred ollars I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS SUED, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California, and agree that if I should become subject to the workers' compensation provisions of Section ;79P o2Me Labor Code, I shall forthwith comply with those 12/17/2008 Signature Date WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for the performance of the work for which this permit is issued. (3097 civ. code) Lenders Address City State Zip Permit No: B08-2456 Issued Date: 12/17/2008 BY TMP Expiration Date: 12/17/2009 Occupancy: Zoning: RT1A Square Footage: Building Garage Remdl/Addn Other Porch/Patio Total Balance Due: $0.00 Receipt No: OWNER / BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License Law for the following reason (Sec. 7031.5), Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's License Law [Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code] or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars [$500); Please check one of the following: 1, AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of the property, who builds or improves thereon, and who does the work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proof that he or she did not build or improve for the purpose of sale.). ❑I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (Sec. 7044, Business and Professions Code: The Contractor's License Law dows not apply to an owner of the property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractor's License Law.). ❑ I AM EXEMPT under Section B. & P.C. for this IX 12/17/2008 Owner's Signature Date 1 I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all City and County ordinances, rules, regulations, and Slate laws relating to building construction, and with any and all conditions of permit. I agree to defend, indemnify, and hold harmless Butte County, its officers, agents and employees from any and all claims and liability for personal injury, including death, and property damage caused by, arising out of, or in any way connected with the issuance of.this permit. I hereby acknowledge that issuance of this permit does not authorize the use or occupancy of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte County to enter the above mentioned property for inspection purposes. I hereby certify that I am the pr;nrtyyw/rier or a�m,author'ze or�the p operty ow�ngfs beh If. l �I AIA d I� tn�� I li fa wtVai.U� h 12/17/2008 ❑ Owner ❑ Contractor OR; DAgent for Owner Agent for Contractor FILE COPY BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION" OFFICE #: (530) 538-7541 FAX.#: (530) 538-2140 A FEE WILL BE REQUIRED AT TIME OFAPPLICATION . Website: www.buttecounty.net/dds PLEASE PRINT CLEARLY PERMIT NO. BIN # "When riled, this application and all supporting material becomes subject to the California Public Records Act. All public information related to this application is subject to public inspection and will be posted on the County's website for electronic access. OWNER INFORMATION Last Name /1 . q r First Name Mailing Address City State Zip Phone03_Q` os Fax E-mail' CONTRACTOR Name oil! IA A A-_ 10 Pt Address�. 10-7 Wctk7Av t-�t Cityy Ct State Zip Phon tNwl „(O o Fax E-mail � � r✓'Gt�we Ct � � � 0 1 � ` ��aS�'I�0 n5. Lic. # W Class G APPLICANT INFORMATION ARCHITECT/ENGINEER Name FloodZone Address Zip R City Falx State Zip Phone Fax E-mail State License Number APPLICANT INFORMATION Name lo n- y n' vv,44"-1A 14vvt Address FloodZone State Zip R Phone/r-3 Falx E-mail(. tt� L APPLICANT SIGNATURE X PROJECT LOCATION API �r. / rl ( / Z Property Address City a, ( —1k I ni WORKER'S COMPENSATION Policy Number Carrier If hiring anyone other than licensed contractors, a certificate of worker's compensation must he shown at the time of perm issuance. LENDING AGENCY Name 141 Address 0M DESCRIPTION OR SCOPE OF WORK. Ace Gt t' S v' w wed 'e_ 0, M Sq FT- Living Garage Open Cov ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): For office use only: Zoning FloodZone SRA Yes No Occ. Type Const. <,�s9C70