HomeMy WebLinkAboutPV2020-109 - Permit Application (2)Print Form heet for Combo Building & Solar Permit Application @9 EW�"m
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F Comm'I r Residential / NOTE: PLAN CHECK FEES DUE AT TIME O'F TTAL ��
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Project Address (Not mailing address) F_ Flood � reX-Li I Landslide L _NfTlr 14vSuite No
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Description of Work
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# Stories', # Units (if Res) i
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Valuation$
Material/Labor D 7
New/Add SF f /0(7 Remodel SF
Garage/New/Add �'
OWNER'S NAME Last
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Owner's Address
Owner's E-mail Address
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City
State Zip �f�.j� � VTelephone %7�L1 -507gqq
APPLICANT'S NAME Last
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Firsts
Applicant's Address
Applicant's E-mail Address
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City U14144+ 71-Aef1 _.
State
Zip 4�'�jt�( Telephone
ARCHITECT/DESIGNER'S NAME
Last
First F Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State—,
Zip Telephoned
ENGINEER'S NAME Last
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First I 1 •601/7 Lic No. F67C5 4
Engineer's Address
Engineer's E-mail Address
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Zip .i P ��
V�n� j cy� Lic No. �lY1�G Class C
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Contractor's Address
Contractor's E-mail Address
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REAR
SETBACKS FRONT
PERMIT NO.
BEASETBACKS
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.
DEVELOPMENT NO
" i -)PLAN CHECK FEES $