HomeMy WebLinkAboutPV2019-135 - Permit Application5
Print Folm Worksheet ffor Colr�bo Building & Solar Permit Application
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL 5..oa+•'
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Project Address (Not mailing address) [_ Flood F" Fire F" Liq F"- Landslide F N/A Floor Suite No
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Description of Work
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OWNER'S NAME Last I A k � ocv lCt l7 First MGt rl r Q Yh
Owner's Address Owner's E-mail Address
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APPLICANT'S NAME Last S+e a eo 5 First I Oct 4 --ti.
Applicant's Address Applicant's E-mail Adddres§
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ARCHITECT/DESIGNER'S NAME Last f -- First I ���_
Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City � State F— Zip Telephoner—
ENGINEER'S NAME Last First I� Lic. No.1
Engineer's Address Engineer's E-mail Address
City r State F — Zip I Telephoned
CONTRACTOR'S NAME/COMPANY /t u ✓ 1, I _ Lic. No. /®Class
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Contractor's Address Contractor's E-mail Address
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SETBACKS REAR SETBACKS FRONT PERMIT N I . '
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $