HomeMy WebLinkAboutX2021-2705 - Permit ApplicationPrint Form__1 Worksheet for Combo Building & Solar Permit Application o�EWRe
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL owr"
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Project Address (Not mailing address) r Flood r Fire F- Liq r Landslide FN/A Floor Suite No
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Description of Work
Use Fw r Const Type
# StoriesF # Units (if Res)F
Valuation
New/Add SFF Remodel SF �Qy
Garage/New/Add F__
$
Material/Labor �D
OWNER'SNAME Last �r/�q
First �9FLJ�
Owner's Address
Owner's E-mail Address
City ��cu Off% Well State �A Zip ( �� Tele hone /�/-
91 �(�� p 7 72c-/S%F
APPLICANT'S NAME Last
First First _S�Tp f7 -
Applicant's Address /
Applicant's E-mail Address
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City State 2'p
Zip ��� Telephone �W _4:-g,-64/(op
ARCHITECT/DESIGNER'S NAME Last q�{�
s First FAEL Lic. No. -��j/�.?
Architect/Designees Address
Architect/Designees E-mail Address
City �«/� State eA
Zip N ;e:)s Telephone 7 -YjF- 26667
ENGINEER'S NAME Last
First [_ Lic. No.F
Engineer's Address
Engineer's E-mail Address
City State F_
Zip F— Telephoned
CONTRACTOR'SNAME/COMPANY jM LIc.No.`z�; ClassF
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Contractor's Addrreeg"s
Contractor's E-mail Address
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City e,,9 Zm✓ State eGI
ZipF?,?FF6 Telephone[;",/ -
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.R �ZQ`fil
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $ 1�� i