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Building Combination Plermit
— COWLETED BY APPLICANT
L a d tion - Tract ud Lot Planning C Number or'- P® -el N b®c
---
Property Address Team i's 7 me q;r�pp lc x
Name one a r Fa umber
Property Add 5u to
Owner 1?ty/Zlp Code
VVIA ,
�•M1iail Add a
N one u ax u r
Applimn Add Site itylZip Code
11 - )3. Iry
L-31211 AUGreSS
o
Ne e Phone Number Fax Number
Add
Suite N.. L ILI Looe
Cun.rac.vr - f r
=L-1V1211ss
Cont ctur's City fts License Number. Cant is State of CaliforniaLicense Number: Cla"Ifi tion'
��
criptio of Work (Incindin ua uare tae) C®et of iYor
::::
Applicant's Signature _ Bate
CLEARANCES REUI_ T
BUILDING AND F i L CERTIFICATE (NCUSD)
i PLANNING i- WATER — -- —
ENGINEERINGri I SJ S T OF HAMNER)
[ -- J S )
c HEALTH DEPARTMENT