HomeMy WebLinkAboutPV2019-200 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
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Project Address (Not mailing address) ❑ Flood Fire ❑ Liq [7] Landslide FIN/Aj Floor Suite No
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OWNER'S NAME Last e7,wTi
7 First
Owner's Address
Owner's E-mail Address _ 11bAD,--
cityk State tJ .ZIP � Telephone
APPLICANT'S NAME Last '
First
Applicant's Address /
Applicants E-mail Address
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ZIP Tel phone
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designer's Address -
Architect/Designer's E-mail Address
city State E:77
Zip Telephoned
ENGINEER'S NAME Last
First Lic. No. 77
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Engineer's Address
Engineers E-mail Address
-city State
Zip Telephone
CONTRACTOR'S NAME/COMPANY p
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Lic. No. , ��" Class G�
Contractor's AddressgJ
Contractor's E-mail Address
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SETBACKS. REAR SETBACKS. FRONT
PERMIT NOS $6i, Z_ 5 I XL6 IC(" d SO
SETBACKS LEFT. SETBACKS RIGHT
PLAN CHECK NO.-�Li�—�-'Z,�.C.�
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $
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