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CITY OF EASTVALE PLCK No: Permit No:618,H—wuc G.5u.-,u, 16-00 3 O
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,xcoeaocwren Date: Date:
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Amount: Ainount, ' A
0. -
Ck#: Ck#:
y752—
Building Combination Permit G b o 0
To Be Completed By Applicant
Legal Description: _ _ Planning Case: F: L: Rt: R
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Property Address: Assessor's Parcel Number:
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ProjecU-penant Name: Unit#: Floor#:
Name: _ S Phony No ,, _ Ll 3 _ Fax No.
'50
Property Add ss; nit Number Zip Gore
Owner lG _ l _ PLACE F� `( 30
Email Address:
Name: Phoftp No. Fax No.
Applicant Address: ' S _ Unit Number Zi Code C
�i� ress:
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Name: P one No. Fax No.
- ALAv� v
Contractor Address: ity State I Zi Code
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?T:r s ity B smess m
tense o. Contractor's City State of Ca ifoiet License No. Classification:
- P-�l
nber of Squares:
-quare Footage IDC4 cJ F
Description of Wor : IpCc, \o?'�d Sk>1t nG—e C.ICr \`> tnf,c�Yi,.:vu �(',dyy-(�erti'1vGJ CAI\ Cost of Work:$ �G
5 s 1M k } \ N YU
pplii antis Si natu e rc�op ' cz w Date:
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T6 ElialCorilpleted By City Staff Only
Indicate As R-Received or N/A-Not Applicable
5 Completes sets of fully dimensioned,drawn to sale plans which include'. 1 set of documents which include
❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Geo Tech/Soils Report(on cot only)
❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8 Y=x 11)
❑ Foundation Plan ❑ Cross Section ❑ Structural Calculations
❑ Plumbing Plan ❑ Single Line diagram for elec.services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shoring Plan ❑ Sound Report-Residential
Class Code: Indicate I New Construction Alteration' Addition' Means/Methods
Work Type: I Repair• Retrofit' Revision to Existing Permit' Required? YES ND
Proposed Building Use(s): Existing Building Use(s):
#Buildings: #Units: it Stories: Will the Building Have a Basement?
Y of N
Bldg. Code Occupancy Group Indicate Indicate it YES or NO Indicate all Geo-tech.Haz.Zone
At Project Construction Sprinkleretl that apply: Coastal Zane
Completion: Type(s): C Of O Noise Zone
Required? YES or NO Listed on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commiss JArch.Review Board Landmark Comm. I Planning Comm.Zoning Administrator
Fee Exempt: City Project Elec.Vehicle Charger Landmark Seismic Retroft Special Case:Bldg.
Official Approval
,pedite Project(s): Child Care City Project Green Building Landmark I Affordable Housing
For Staff Use Only
L
Building/Salety Permit Specialist City Planning Civil Engineering EPWM-Admin I Transportation Mgmt Rent C t of
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