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Wor"�'Iret for Combo Building & Solar Permit Application ,F
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NOTE: PLAN CHECK FEESESDUE AT TIME OF SU�..BMITTAL
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Project Address (Not mailing address) F- Flood j- Fire r Liq F Land�ide Igor Suite No .
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Description of Work
Use I Const Type F_
# StoriesF_ # Units (if Res)F—
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New/Add SF�— — Remodel SF Garage/New/Add
Valuation $
Material/Labor
OWNER'S NAME Last f3o 11bo4 jam. C[,,...b First
Owner's Address Owner's E-mail Address
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City �.�WPpC-� SP1y,�� State Zip Q3 -1p4.3 TelephoneF,g-Smoc)
APPLICANT'S NAME Last First
Applicant's Addrek)v Applicant's E-mail Address
City State F— Zip Telephoned—
ARCHITECT/DESIGNER'S NAME Las Fi Lic. No. �—
Archit UDesigner's dres Architect/Digners -mail Address
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ENGINEER'S NAME Last c�r i First (Y1Z50uLc1 Lic.No. S -3 a-.
Engineer's Address Engineer's E-mail Address
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City Let- ForeS* State En Zip gac.3o Telephone a,D/o-
CONTRACTOR'S NAME/COMPANY S h ill mo k e.r (r1 r • Lic No. WZ 1 -F3r-{ Class TB
Contractor's Address Contractor's E-mail Address
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City I cors- me-sn State�0_R Zip Fqa v a.7 Telephone $L�B- $3.�
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SETBACKS REAR SETBACKS FRONT PERMIT NO. [t
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NO. ^ K"
SETBACKS LEFT. SETBACKS RIGHT PLAN CHECK l� C7
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $