HomeMy WebLinkAboutX2018-2934 - Permit Application1_1 -'„I, vvorKsneer Tor c;Omao building & Solar Permit Application `vim?6O
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NOTE: PLAN CHECK.FEES nt 1F AT TlAAr nF m ianAIT Ai
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Project Address (Not mailing address) ❑ Flood M Fire [J Liq r Landslide ❑N/A Floor Suite No
Description of Work
Use r Const Type
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New/Add SF Z 5 Remodel SF � Garage/New/Add �Valuation $
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OWNER'S NAME - — J
Last First GGr'�` /4
Owner's Address Address - Owner's E-mail Address
City .State..Zip Z Z Telephone
APPLICANT'S NAME Last � �`,�.Z-� First
Applicant's Address Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME LastFirst �-
Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
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City �- -_. State L J Zip --I Telephoned
ENGINEER'S NAME Last FirstJ Lic. No.�7
Engineer's Address - Engineer's E-mail Address -
city -- _ _— State Zip �� Telephoned_
CONTRACTOR'S NAME/COMPANY Lica No.Class
Contractor's Address Contractors E-mail Address. -
city State moo/. Zij j9 j;777TelephoneF�%! /, l3G j
SETBACKS REAR SETBACKS FRONT (i�� PERMIT NO.
SETBACKS LEFT tj SETBACKS RIGHT �j PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $