HomeMy WebLinkAboutX2021-0479 - Permit ApplicationF rinf Form {`.• 'Worksh t for Combo Building & Solar Permit -Application ` =` WRIN .'-
rj Comm'I rj Residential
� Ry U ipgwpur t Deacn - Duuaing uivision y0
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITT 1/
?11
[Building ['I Grading
Drainage jElec E,,Mech [—plum cuvdcut C cuvdFill
Project Address (Not mailing address) [' Flood ❑Fire [ Liq L Landslide SIN/A Floor Suite No
Description of Work
Use F Const Type t,
# Stories[_ # Units (if Rest
Valuation $
Material/Labor —
New/Add SF
Remodel SF �— Garage/New/Add �—
OWNER'S NAME Last First
Owner's Address
Owner's E-mail Address
__�a2i�gnati
Lrn_ FFJ
''11 II''�- C�ty ��State ClGE Zo Telephone �`%q-Z�o' g�%
APPLICANT'S NAME
Last 2 S First
Applicant's Address -
Applicant's E-mail Address
City
State Zip Telephone—
ARCHITECT/DESIGNER'S NAME Last — First t Lic. No.
Architect/Designer's Address
Architect/Designees E-mail Address
City
State Zip[ Telephoner
ENGINEER'S NAME
Last— First Lic. No. F—
Engineer's Address -
` Engineer's E-mail Address
_ -- — — — --
City State Zip �- Telephoner
— -- —
CONTRACTOR'S NAME/COMPANY I Lic. No.Class
X65554 G2�
Contractor's Address
Contractor's E-mail Address
t` 2771
City
- OgrlrZ w)oc ULR-67A Came , CQ✓/ -t
'
-
--- -State Telephone Zip26210-
99—i3gz-79
SETBACKS REAR
SETBACKS FRONT
_�� PERMIT NO.