HomeMy WebLinkAboutX2021-0422 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMI AL. ,a
rBuilding Grading rDrainage [Flet Mech
r.-.; Plum cu yd cuts Cu Yd Fill ,
Project Address (Not mailing address) (- Flood F_ Fire r Liq F_ Landslide [-N/A Floor Suite No
of Work
Use F7 Const Type
# Stories[— # Units (if Res)s
- - - -- - g -- --- -- Valuation $
New/Add SF� Remodel SF� Garage/New/Ad a/New/Add Material/Labor
OWNER'S NAME Last
Owner's Address
City State
APPLICANT'S NAME Last
First
Owner's E-mail Address
Zip
Applicant's Address
- --- -- -
City State F
First
Applicant's E-mail Address
- ........ ------- .------ --------
Telephones »
ARCHITECT/DESIGNER'S NAME Last First r! Lic. No. I—
Architect/Designer's Address
City �— State F
Architect/Designer's E-mail Address
Zip F_ Telephoned
ENGINEER'S NAME Last First Lic. No.1—
Engineer's Address
City State F
Engineer's E-mail Address
----- -.... ------- .-..- --
Zip �— Telephoned
CONTRACTOR'S NAME/COMPANY Lic. No. Class
Contractor's Address
City State F—
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT
USE ZONE
SETBACKS RIGHT
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Contractor's E-mail Address
,Zip s— Telephone®
PERMIT NO.
PLAN CHECK NO.
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