1108 Springfield Dr PLAN REVIEW ROUTER CITY OF CA -PBELL
1 1 ew Submittal ❑Resubniittal: (2nd,3rd 4w den Review) ❑Revision to Existing Permit
RECEIVED ' r / APN
APPLICATION/PERI\4IT# JOB ADDRESS
JOB DESCRIPTION `• ST
❑COMMERCIAL �,IESIDENTIAL
Plans RECIEVED
Structural Calcs. WVSD
_Soils Report ' _School Fee Fonn
Truss Calcs. —Health Department Approval
a T-24 Cales. Response Letter
S� _ I�iitial
uilding
n Checked By CI7`rd3F,GAWp' ,;, Date:
Structural Plan Checker: Date:
❑APPROVED ❑NOT APPROVED
fanning Zone:
Checked By: Date:
❑APPROVED ❑NOT APPROVED
W
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Public Works
P Checked By: Date: �^ "Zc��Z'
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APPROVED <lc%% o c1&-I-ict) ❑NOT APPROVED a
❑Fire
Plan Checked By: Date:
❑APPROVED ONOT APPROVED
PERMIT A.PPIKATION PERMIT Ga2t
CITY OF CAMPBELL-BUMANG DIVTMON
BUILDING ADDRESS: SurrE i
PE UVUT TYPE: BUELDnvG / ELECTWC-AL 'Y-�PLZ M]NG!2�"ANICAL
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DEMOLITION SIGN GRADING- OTHER
DEMO NS
IDESCRI3'TI OF WORK: RES, CUNIM. SIG OTHER
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VALUATION j
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OWNER'S NAME: �`j ��}t�®�9 PHONE*- �� 4
ADDRESS: �c�'� S�'�%1�Fx�i }3 ?�• %.
CITY: ZIP: 930 U E
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APPLICANT'S NAME: PHONE#: 4L
ADDRESS: I✓]t> SPAl �v
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CITY: Z1P:__ �StSI` E
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CONTRACTOR'S NAME: I J LICENSE#
CONTACT PERSON: PHONE#:
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ADDRESS:
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CITY: UP:
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/ENG NAME: ev
CONTACT PERSON: 1 HONE#:
ADDRESS:
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CITY: ZIP: `9
HAZARDOVS MA : SED ON SITE: YES NO STORED ON SITE: YES NO I
(For we or storage of pardons materials,provide a HZiM- Information Statement to the Fire Deist.Hazardous Materials
Specialist for review and comment I
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FM SP'RDMLH M-. YES NO
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