HomeMy WebLinkAboutX2017-2140 - Permit Applicationuo1'I ���1oio
Worksheet fo om o ui mg & Solar Permit Application
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r Comm'I I� Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Flood F- Fire f—Liq r Landslide N/A Floor Suite No
Project Address (Not Ma
CP Cc�'7 o N I
Description of Work -e
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del 5 Garage/New/Add F' Material/Labor
New/AddSF�— — '
-0WNER'SNAME Last /"� �//VB�TYILP/5 First
Owner's Address Owners E-mail Address ,
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City State Zip Telephone _. Gy,C( 4 a,57-($ Z.
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APPLICANTS NAME Last 9u f✓1 /(?� First e Mitis e '
Applicant's E-mail Address
Applicants Address
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_ — Zip Telephoned--
City State F
ARCHITECT/DESIGNER'SNAME Last First— Lic.No. 330!;s
Architect/Designers Address ArchitectrDesigners E-mail Addresss
City
State �— Zip F—
Telephoned
\ FirstF - Lic.No.�-
� ENGINEER'S NAME Last �—
Engineers E-mail Address
Engineer's Address
City
State �— Zip Telephonen Lic. No. 9 q3 55-2 Class
CONTRACrOR'SNAME/COMPANY C�lC DLeV-elOrpyw,-Py'-�T14c
` Contractors Address /[ Contractaes'E-mail Address
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City W� r T� 2 r State C�— Zip �(� �j d y Telephone 3,i J!5 / SJ Z
i_TBACKS REAR SETBACKS FRONT PERMIT NO.
TBACKS LEFT SETBACKS RIGHT T PLAN CHECK NO.
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