HomeMy WebLinkAboutPV2021-119 - Permit Application (2):,,'Pont Foam' ,i Worksheet for Combo Building & Solar Permit Application ops" °Rm
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL ,oa
rBuilding F_ Grading Drainage [Elec F—Mech (—Plum cu ydcut� cuvdFill
Project Address (Not mailing address) f, Flood r Fire F- Liq F_ Landslide (-N/A Floor Suite No
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Description of Work Use s Const Type F'
# Stories # Units (if Res)s
_ 5 -36 WuG�ovw
Valuation $
New/Add SF� Remodel SF F__ Garage/New/Add F Material/Labor
OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
City State Ir Zip [77777 Telephone
APPLICANT'S NAME Last F7M First
......
Applicant's Address Applicant's E-mail Address
City State F_ Zip F— Telephoned
ARCHITECT/DESIGNER'S NAME Last First Lic. No. �—
Architect/Designer's Address ArchitecUDesigner's E-mail Address
City State I Zip Telephoned
ENGINEER'S NAME Last First Lic. No.
Engineer's Address Engineer's E-mail Address
City State �® Zip �— Telephoner —
CONTRACTOR'S NAME/COMPANY o ati C.Y , Lic. No. t� Class GC(
Contractor's Address Contractor's E-mail Address
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City U` v � - � State �a Zip � Z (, �O Telephone q S®Z '
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USEZONE DEVELOPMENT NO PLAN CHECK FEES$