HomeMy WebLinkAboutX2021-2206 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application, q
r Comm'] r Residential NOTE: Pity of LAN CHECK FEES Beach
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Description of Work
Use ConstType
#Stories #Units (ifRes)F_
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New/Add SF ��
Remodel SF�-- —�- Garage/New/Add r-.----
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Valuation
Material/Labor bor) O�
OWNER'S NAME
Last <.i L2J /,c First
Owner's Address
Owner's E-mail Address
City %'-( !.� / n-�
_ _State Zip F_ Telephoner—
APPLICANT'S NAME
Last vD �%� '" P
\ A First
Applicant's Address
Applicant's E-mail Address
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City U !
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State L l Zip Telephone -� -/ ,�
ARCHITECT/DESIGNER'S NAME Last First- Lic. No.
Architect/Designees Address
Architect/Designees E-mail Address
City
State I_-_— Zip ..__ Telephoned—_.—._
ENGINEER'S NAME
Last First Lic NoT --
Engineer's Address
Engineer's E-mail Address
City
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State ' Zip �— Telephoner
CONTRACTOR'S NAME/COMPANY l j Lic No. ' j-,L")jj / Class / - `� )
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Contractor's Address
Contractor's E-mail Address
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City L& T -
State Zi / l i Telephone
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. ROM-
USEZONE
DEVELOPMENT NO PLAN CHECK FEES $ ) /) � - I