11194 (SFD)53-880 VILLA
Building
Ti -4 4 .&Qui«ru,
P.O. BO
78-105 CAL
LA QUINTA, CAL
Owner
W.E.S. Development
Address 4102 Marble Ridge Rd
City Zip Tel
Shingle Sngs 9568? 946/676-y3300
Contractor
StQakman Homes
Address
same as above
City Zip Tel.:
State Lic. City
& Classif. B1 642345 Lic. #
Arch., Engr.,
Designer St ld�io 4
Address Tel.
949 Unive--rsity #E100 916/920-11.5.9
City Zip State
Sacramento Lic. # 2.2044
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions; of=Chapter,!, commencing with Section -
7000) of Division 3 of the°Business and ProfessionsiCode,'and my9I ense is in full force and
effect.
OWNER -BUILDER DECLARATION '
I hereby affirm 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, which requires a
permit to construct, atter, improve, demolish,. or repair any structure, pdor'to its issuance also
requires the applicant for such permit to file a signed statement that he 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 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).
❑ I, 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, Buisness and
Professions Code:.The Contractor's License Law does<not apply to an owner of property who,
builds or improves thereon and who does such work himself or through his 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 proving that he did not build or improve for the purpose of sale.). ,
O I, as owner of the property, am.exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business' and Professions Code: The Contractor's License Law
does not apply to an -owner of property;who builds or Improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent'to self -insure; or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
rI Copy. is filed with the city. 0 Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (8100) valuation
orless.) -
I 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 Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT. If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated; and is subject to
expiration if work thereunder is suspended for 180 days.
I 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 and state' laws relating to building
construction, and hereby authorize representatives .of this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
X 1504LE ESTADO 1 r !' N 0. 1119 4
IFORNIA 92253
v
11LDING: TYPE CONST. OCC: GRP.
P. Number 774-174-009
!gal Description Lo 18 Bleck 250
Plan 2
.oiect Description
Sq. Ft. 1471 No. No. Dw.
Size - Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Permib does not include block walls or
poo3.... .
• t
Estimated Valuation
435,042.90
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
494.63
Const.
576.50
Mech. '
62.00
Electrical
123.71
Plumbing
144.00
S.M.I.
8 .
Grading
20.00
Driveway Enc.
.00
Infrastructure
1913.47
Prec sil,ePlan
25.4)U
TOTAL
REMARKS"
AnlrzA A! _ f% -i X51, 07-1-411-9.2 „, 10
.3.V S.ffci: L fLriUxl.. I. :;VQe ♦: A
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL SO. FT. ®
FOR. SQ. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. FT. ®
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
i
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
IA
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
-
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR -SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
ROUGH WIRING.
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SO. FT.® c
BATH TUB
OTHER APPJEOUIP.
SO. FT. ® c
WATER HEATER '
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
GROUT
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEEPL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBIN
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
IA
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
Z�OSEWER GB.B6PI: _ZAAK
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE C��l
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ -plus-x$_=$
LUMBER GR.
FINAL INSP. t` l
FRAMING ® 7 G
FINAL INSP.
ROOFING
VENTILATION
/ /!f
�// ^q
Prcj
i
1D)A0REMARKS:
� �L �B�
vcj
r Why
C
FIRE ZONE ROOFING,
'e ALL
94 Ce
FIREPLACE
qr
P;WS v1
SPARK ARRESTOR
1�
GAR. FIREWALL
THING 0 ��
MESH
INSULATIONISOUND v
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
CIL
_P
` GRANT DEED '
RECORDING REQUESTED BY )
AND WHEN RECORDED RETURN TO )
AND MAIL TAX STATEMENTS.TO: )
LA QUINTA REDEVELOPMENT AGENCY )
78-105 Calle Estado )
La Quinta, California 92253
Attn: Executive Director )
Space above this line for Recorder's use
Document transfer tax is:
R.T. SECT. 11922
LA QUINTA REDEVELOPMENT AGENCY
,. By: t�
Dated
GRANT DEED
For a valuable consideration receipt of which is hereby
acknowledged,
LA QUINTA REDEVELOPMENT AGENCY,, a public.body,"corporate
and politic, of'the State of California, herein called
"Grantor" or "Agency",acting to'carry out that certain
Redevelopment Plan (herein called "Redevelopment Plan") for the
La Quinta Redevelopment Project No., 1 -,.herein called "Project",
under the Community Redevelopment Law of California, hereby
grants to WES DEVELOPMENT COMPANY ,-a California corporation,
herein collectively called "Grantee" or "Developer", the real
property hereinafter referred to as "Property," described in
Exhibit A attached hereto and incorporated herein, subject to
the existing easements, restrictions and covenants or record,
if any, set forth on Exhibit A.
Unless stated otherwise, all capitalized terms herein shall
have the same meaning'as set'out in -the DDA (described in
Section 1 hereinbelow).
1738Q/2338/24 Page 1` of- 7 . ,
Section 1. Uses
For a period commencing upon,July 1992 [date of
recording of Grant Deed] and expiring on December 29, 2118 (the
"Affordability Period"), the Property may only be used for the
construction and residential use of single-family housing to be
sold at Affordable Housing Cost as such term is defined by
Health and Safety Code Sections'33339.2 and 50053 and occupied
by persons and households of Very Low, and Low to Moderate
Income as defined in Health and Safety Code Sections 50105 and
50093, respectively, and -subject to the limitations of, that
certain Disposition and Development Agreement dated as of
April 26, 1992 between Grantor and Grantee (the "DDA"), a copy
of which is on file with the Agency as a public record and is
incorporated herein by reference, and the Redevelopment Plan.
Section 2. Obligation to Refrain From Discrimination
The Developer covenants by and for itself, and any
successors in interest, that there shall be no discrimination
against or segregation of any person, or group of persons, on
account of sex, race, color, religion, creed, marital status,
national origin or ancestry in the sale, lease, sublease,
transfer, use, occupancy, tenure or enjoyment of the Property,
nor shall the Developer itself or any person claiming under or
through it establish or permit any such practice or practices
of discrimination or segregation with reference to the
selection, location, number, use or occupancy of tenants,
lessees, subtenants, sublessees, or vendees of the Property.
Section 3. Form of Nondiscrimination and Nonsegregation
Clauses
The Developer shall refrain from restricting the rental,
sale or lease of the Property on the basis of sex, race, color,
creed, religion, marital status, ancestry or national origin of
any person. All such deeds, leases or contracts shall contain
or be subject to substantially the following nondiscrimination
or nonsegregation clauses:
(A) In deeds: "The grantee herein covenants by and for
himself, his heirs, executors, administrators and
assigns, and all persons claiming under or through
them, that there shall be no discrimination against or
segregation of, any person or group of persons on
account of sex, race, color, creed, religion, marital
status, handicap, national origin.or ancestry in the
sale, lease, sublease, transfer,'use, occupancy,
tenure or enjoyment of the land herein conveyed, nor
shall the grantee himself or any person claiming under
or through him, establish or permit any such practice
or practices of discrimination of segregation with
1738Q/2338/29 Page 2 of 7
reference to the selection, location, number, use or
occupancy.of tenants, lessees, subtenants, sublessees
or vendees in the land herein conveyed... The foregoing
covenants shall run with the land."
(B) In leases: "The lessee herein covenants by and for
himself, his heirs, executors, administrators and
assigns, and all persons claiming under or through
him, and this lease is made and accepted upon and
subject to the following conditions:
That there shall be no discrimination against or
segregation of any person or,group of persons on
account of sex, race, color, creed, national origin or
ancestry, in'the leasing, subleasing, transferring,
use.,.or enjoyment of the land herein leased nor shall
the lessee himself, or any person claiming under or
through him, establish.or permit any such practice or
practices of discrimination or segregation with
reference to the selection, location, number, use or
occupancy, of tenants,'lessees, sublessees, subtenants
or vendees in the land herein leased."
(C) In.contracts: "There shall be no discrimination
against or, segregation,of, any person, or group of
persons on account of sex, .race, color, creed,
religion, marital status, national origin or ancestry
in the sale, lease, sublease, transfer, use,
occupancy, tenure or enjoyment of the land, nor shall
the transferee himself or anyperson claiming under or
through him,.establish.or permit any such practice or
practices. of.discrimination or -segregation with
reference to the selection, location, number, use or
occupancy of tenants, lessees, subtenants, sublessees
or ven.dees of the land.
Section 4. Effect and Duration of Covenants
Grantee, and any successor to Grantee, shall only be
responsible for and liable for the performance of the
provisions of Sections 1, 2, 3 and' -10 during such period of
time as it shall be.the.owner of.the Property.
Section 5. Covenants for the Benefit of Grantor
All covenants set forth in Sections 1, 2,,3, 9 and 10 of
this Deed without regard to technical classification or
designation shall -be binding for the benefit'of the Grantor,
and such covenants shall run in favor of the Grantor for the
entire period during which such covenants shall be in force and
effect, without regard to whether the Grantor is or remains an
owner of any land'or interest therein to which such covenants
relate. The Grantor, in the event of any breach of any such
covenants, shall have the right to exercise all the rights and
remedies and to maintain any actions at law or suits in equity
or other proper proceedings to enforce the curing of such
breach.
Section 6. Mortgage Protection
No violation or breach of the covenants, conditions,
restrictions, provisions or limitations contained in this Grant
Deed shall defeat or render invalid or -in any way impair the
lien or charge of any mortgage or deed of trust, provided,
however, that any subsequent owner of the Property shall be
bound by such remaining covenants, conditions, restrictions,
limitations and provisions, whether such owner's title was
acquired by foreclosure, deed in lieu�of foreclosure, trustee's
sale or otherwise.
Section -7. Amendments -
Both Grantor, its successors and assigns, and Grantee and
the successors and assigns of Grantee in and to all or any part
of the fee title to the Property shall have the right to
consent and agree to changes in, or to eliminate in whole or in
part, any of the covenants, easements or restrictions contained
in this Grant Deed withouttheconsent:of any tenant, lessee,
easement holder, licensee, mortgagee, trustee, beneficiary
under a deed of trust or any other person.or,entity having any
interest less than a fee in the Property. The covenants
contained in this Grant Deed, without regard to technical
classification shall not benefit or be enforceable by any owner
of any other real property. Any amendments to the
Redevelopment Plan which change the uses or development
permitted on the Property, or otherwise change any of the
restrictions or controls that apply to the Property, shall
require the written consent of Grantee or the successors and -
assigns of Grantee in and to all or any part of the fee title
to the Property, but any such amendment shall not require the
consent of anyrtenant-, lessee, easement holder, licensee,
mortgagee, trustee, beneficiary under a deed of trust or any
other person or entity"having any interest less than a fee in
the Property.
Section 8. 'R_ight to Repurchase and Re -Vest Title to
Property
The Agency has the additional right, at its option, to
reenter and take possession of the,Property, with all
Improvements thereon, and terminate and revest in the Agency
the estate conveyed to the Developer, if the Developer (or its
Successors in interest) shall:
1738Q/2338/24 Page 4 of 7
1. Fail to start the construction of the
Improvements as required by this Agreement for a
period of forty-five (45) days after written
notice thereof from the Agency; or
2. Abandon or substantially suspend construction of
the Improvements required by this Agreement for a
period of forty-five (45) days after written
notice thereof from the Agency; or
3. Transfer or suffer any involuntary transfer of
the Site(s), or any part thereof, in violation of
this Agreement.
4. Fails to transfer the Site(s) pursuant to the
terms of this Agreement within two (2) years of
the execution the DDA by the Agency, namely
April 26, 1992.
Such right to reenter, terminate and revest shall be
subject to and be limited by and shall not defeat, render
invalid or limit:
1. Any mortgage or deed of trust permitted by this
Agreement; or
2. Any rights or interests provided in this
Agreement for the protection of the holders of
such mortgages or deed of trust.
Upon the revesting in the Agency of title to the
Property, the Agency may, but is not required, to use its best
efforts to resell the Property as soon and in such manner as
the Agency shall find feasible and consistent with the
objectives of the state redevelopment law and of the
Redevelopment Plan, as it may be amended, to a qualified and
responsible party or parties (as determined by the Agency) who
will assume the obligation of making or completing the
Improvements, or such other improvements in their stead as
shall be satisfactory to the Agency or who will assume the
ownership, management, and operation of the Site(s) all in
accordance with the uses specified herein and specified for the
Site(s) or part thereof in the Redevelopment Plan. Upon such
resale of the Site(s), the proceeds thereof shall be applied:
1. First, to reimburse the A.gency, on its own behalf
or on behalf of the City, for all costs and
expenses incurred by the'Agency, including, but
not limited to, any expenditures by the Agency or
the City in connection with the recapture,
management and resale of the applicable Site or
.part thereof (but.less any income derived by the
1738Q/2338/24 Page 5 of 7
Agency from the applicable Site or part thereof
in.connection with such management); all taxes,
assessments and water or sewer charges with
respect to such Site or part thereof which the
Developer has not paid (or, in the event the Site
y is exempt from taxation or assessment or such
charges during the period of ownership,thereof by
the Agency, an amount, if paid, equal to such
taxes, assessments, or charges as would have been
payable if such area were not so exempt); any
payments made or.necessary to be made to
discharge any.encumbrances or.liens existing on
the Site or part thereof'at the time of revesting
of title thereto in the Agency, or to discharge
or prevent from attaching or being made any
subsequent encumbrances or liens due to
obligations, defaults or acts of the Developer,
its successors or transferees; any expenditures
made or obligations incurred with respect to the
making or completion or operation and management
of the Improvements or any part thereof on the
Site, or part thereof; and any amounts otherwise
owing the Agency, the Developer and its successor
or transferee; and
2. In the event additional proceeds are thereafter
available,. then; Second, to reimburse the
Developer, its successor_ or transferee, up to the
amount'equal to the sum of:(,a) the Purchase Price
paid -to the Agency by the Developer for the Site;
and (b). the costs incurred by the -Developer for
the development of the Site, and for the
Improvements existing on the Site at the time of
the reentry and repossession, less, (c) any gains
or income withdrawn or -made by the Developer from
the Site or the Improvements.thereon.
Any balance remaining°after such reimbursements shall
be retained by the Agency as -its sole property.
The rights established in this Section 8 are to be
interpreted in light of the fact that 'the Agency conveyed the
Property to the Developer for development of housing available
at an affordable housing cost, to persons and families of low
to moderate income; -and not for speculation in undeveloped land.
Section 9. Sales' Or Transfer of Property
Grantee covenants that he shall riot make any sale,
transfer,. conveyance or assignment of the Property or any part
thereof or any interest therein without the prior written
consent of Grantor, in accordance with;the DDA.
1738Q/2338/29 Page 6 of 7
STATE OF CALIFORNIA
COUNTY OF RIVERSIDE
On this 23rd day of July, 1992, before me, the undersigned, a
Notary Public in and for said County and State, personally appeared
Walter E. Stockman, personally known.to me, to be the President -of
WES Development Company, a California,Corporation, that executed
the within instrument .and known. to me to' be the persons who
executed the within instrument on behalf of the corporation therein
named, and acknowledged to me that such corporation executed the
same, pursuant to its by laws, or a resolution of its Board of
Directors.
WITNESS my hand and official seal.
OFFICIAL SEAL
DE80RA0 S. DE RENARD
NOTARY PU - culF71A4
wv�q caunn
I: L�Ca l(�7l C�-ri 1h Comm Expfra9 Jan. 199
Deborah.S. DeRenard, Notary
E ' VIII • him
(0-6
-
OF
s 4 C tit of Ka Matutar
Cutltn �tn5'�t�1 tnt�t'ui �3
This'r Certificate issued pursuant to the requirements of Section 306 of the Uniform Building
Code certifying that at the time of issuance this structure was in compliance with the various
_ ,,, ordinances of the City regulating. building construction or;use. For the following:
`BUILDING ADDRESS 53-880 Villa
Use Classification Single= Family Dwelling' Bldg. Permit No. 11194
Group R'A v ' Type Construction XZN Fre Zone Use Zone sR
Owner of Building W.E.S. - Development Address 4102 Marble Ridge
city Shingle Springs, CA BY; Lonnie Day
Dote. December 3, 1992
Building Of
POST IN A CONSPICUOUS PLACE
Building DO P.O. BOX 1504 APPLICATION ONLY
AddressFORNIA 92253
Mailing �%/
Address "�,7--G D
=,I , T- 'BUILDING: TYPE CONST. OCC. GRP.
P. Number
Tel.
k Jr- Legal Descripti
Addre r ' I
Cit � Z Tel.
State Lic. City
& Classif.Lic. # //00
Arch., Engr.,
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACT R'S DECLARATION
I hereby arm that I am I- under pr ions of Chapter 9 (commencing with Section
7QDOj of I Ision 3 of the usl sand Pr sions Code, and my license is in full force and
OWNER -BUILDER DECLARATION
I hereby affirm 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 which 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 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 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 (S500).
I, 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, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his 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 proving that he did not build or improve for the purpose of sale.)
1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of properly who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
- I am exempt under Sec.-B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
Copy is filed with the city. G Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less )
I certify that in the performance of the work for which this permit is issued, I Alrall not
employ any person in any manner so as to become subject to the Workers' Competiaation
Laws of California.
Date_ Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec 3097, Civil Code )
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I coolly that I have read this application and slate that the above information is correct.
I agree ID comply wish at[ city and county ordinances and state laws refacing to building
cbnstruttinn, and hereby authorize representatives ,of this city t0 enter the abrnre-
menlionod pf0party for m5pecikon purposes
Signature of applicant Date
Mailing Address
City, State, Zip_
Project Description
//V)
Izz7T- / - —
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const,
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
l P" r
ZONE: BY: r
Minimum Setback Distances: . "
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
FINANCE