Lot 543 (school) "40 5�w
CITY OF EASTVALE C PECK No: Permit No:
me.ae.ew>,sea..s yO ��• 0011
INCO[POG�� Date: Date:
CZ 10
Amount. $ 6ys. `t<o
5
10 Ck Ck#:
Building Combination Pe�;ta�fiQ� �p S-6 c4��
To Be Completed By Applicant
Legal Description: Plannin9 Case:
lorz Property Address: Assessor's Parcel Number.
Project/Tenant Name: Unit#: Floor#:
Name: Phone No. Fax No
Property Address: Unit Number
Zip Code
Email Address:
Name:
Applicant Ad re Um Number Z• e
maj
Eam e
Name: ` o
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Contractor Address: ate p .,
ra cerise a. Contra oY S if License No.
si 1
nberof Squares:
square Footage
a
Description of Work: j Cost of Work.
Applicant's Si r t,
.� Date: If
t"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: t set of documents which include
❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Geo Tech/Solis Report.(on cd only)
❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8%x 11)
❑ Foundation Plan ❑ Cross Section ❑ Plumbing Plan ❑ Structural Calculations
❑ Single Line diagram for elec.services over 400 AMP
❑ Floor Plan ❑ Structural Framing%anBDeta�s ❑ Shoring Plan ❑ Sound Report-Residential
Class Code: Indicate New Construction g�Buildlnq
Addition' Means/Methods
Work Typo. Repair" _ Revisbn to Exisgng Permit' Required? YES NO
Proposed Building Use(sj: - ilding Use(s):#Buildings: #Units: #Stories: Will the Building Have a Basement?
Y of N
Bldg.Code Occupancy Group Indicate Indicate ife all Geo-tech.Haz.Zone
At Project s rinklered YECompletion: Construction p ply: Coastal Zone
Type(s): C of O YENoise Zone
RequiredaListed on Historic Resources Inventory
CITY-
PLANNING STAFF ONLY
APPROVALS: Costal Commiss Arch.Review Board Landmark Comm. Planning Comm.Zoning Administrator
Fee Exempt: City Project Elec.Vehide Charger Landmark Seismic Retrofit P ass:el g.
OmdalA oval
-edite Project(s): Child Care City Project Green Building Landmark Affordable Housing
For Staff Use Only
Building/Salary I Permit Specialist City Planning I Civil Engineenng I EP M-Admin Trans onahon IIIP gmt. Rent Control
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