HomeMy WebLinkAboutX2018-1742 - Permit ApplicationX2018 - I -i9 Z
' > Pnht.FoYm:=. Worksheet for Combo Building & Solar Permit Application
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) ❑ Flood ❑ Fire ❑ Liq ❑ Landslide ❑N/A Floor Suite No
22S VIS- Qn0 50UP
Description of Work Use s Const Type 0
Ro (.INC COLIC wFltt_ �{2 N
y # Stories # Units (if Res)❑
&MC- L,O 11 0 t
Valuation F977fc7cz)]
New/Add SF Y,/ Remodel SF �I Garage/New/Add rt/ f} Material/Labor bor
OWNED NAME Last I G` u 12 C 1 FAtutc y T
Owner's Address
City I 'BqC,(3,11f, ISCA-,J0 State
Firstl 5 ANer
Owner's E-mail Address
M 131 RKC-TOSEAMISSI•Co A
Zip ` -L4&7 TelephoneI�ve�
APPLICANT'S NAME Last I -3,K [3 ) Cv—( I First (A (J- e- (z
Applicant's Address
?10 3wy
City I brit CHID Ami "I4164AJ4 State L�
Applicant's E-mail Address
5Kt&iCK(CON5TYl-UC-nc�^106M+lt,e_0M
Zip z7W_ Telephone g(%g73v —e 6 7
ARCHITECT/DESIGNER'S NAME
Last S ( (6 First RiW({j-/J Lic. No.
ArchitecttDesigner's Address
(� 0 I~O�JE7-A D2lvr:
city D F (_ MP- E State
Architect/Designer's E-mail Address
Zip Telephone Qj�jg-��5"meg 32
ENGINEER'S NAME Last SII PS�� 1 �S�G First W(((� Lic. No. 5 gt2-
Engineer's Address
Z3 0Q.C14AO-1) Su 1rc ZSD
City` •�v ,Si State C` -
Engineer's E-mail Address
S•� (<A l4AN.10WSRSc. CVM
Zip �Z(p7jQ TelephoneF�
' JOCONTRACTOR'S NAME/COMPANY I 00A_ ST NG��iE Lic. No. 55 831 Class
Contractor's Address
3�IS6 prvvttrvo a�atSm�i�v Su�rt: A --4o
City 5� LlV� l5(GWND State 77F 47
SETBACKS REAR — , SETBACKS FRONT
SETBACKS LEFT �_ SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
Contractor's E-mail Address
C VR ---r40 CCM-00(ZP NET
ZipFqZ;7S7 Telephone Zi%- 93-R
PERMIT NO. )<LD k'6 --- M
PLAN CHECK NO.
PLAN CHECK FEES $
SK(8(ctK co�S -
550 - 3 I
13CN 9®D-0 (
5 K B Ick1c D►�sTc2Uc t'� 0 G—MA t eoM