HomeMy WebLinkAboutX2022-0107 - Permit ApplicationPrint Form
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Worksheet for Combo Building & Solar Permit Application
Residential NOTE: PIty of LAN CHECKrt EBeach - ES DUE Building AT TIME OF (sion SUBMITTAL Xa�aa. _010}
L�/_Building F Grading F-Drainage P41ec Jj;4ech Plum CuvdCut F_ CUYdFill F_
Project Address (Not mailing address) F Flood F- Fire F_ Liiq F_ Landslide F-N/A Floor Suite No
355 Pl�cPtt�t� Avi� SaAes 202, 43, )VU NelOrf /3ea , CA F
Description of Work
f n Type �Q
Use I � ConstT e
_
7.1 all Ski+ec 2D2 & ,Ty3. f0 Cvkneri exis�in9 210.
7/o ,f'I-46
# Stories # Units (if Res)
,wigS neiJ wiv,clows "a,4 02 5� (� k+S Closi�
o Y � j ays-�r��h� doors,
A44 I-aLPu'- a),—.Jf..e 4JI
Y
New/Add SF r Remodel SF 2 18 5 Garage/New/Add F—
Valuation $ 0
MateriaVLabor%() 0 d
OWNER'S NAME Last /1/,lcmvam First spa,vt.
Owner's Address Owners E-mail Address
355- Plve,+ 'A /}ve, Su. <e 9g �i/cvavc��jm ;/, to",,
City q/rnPor% &r� State LfE Zip 9,2G6 3 Te✓elephone 71y _ 3 66 - V� 6
APPLICANT'S NAME Last za s;M_4 First 10k'r_"*zV
Applicant's Address Applicant's E-mail Address
/`f22 C !ekoi /F✓C- 0-oz6l 3unlu;s4kith)-s-C,,-
City �y�(6 State F eA Zip 9(0b.0 Telephone 6Z-78B-GyBs
ARCHITECT/DESIGNER'S NAME Last First F— Lic. No. F_
Architect/Designers Address Architect/Designers E-mail Address
City State F__ Zip �—T Telephone
ENGINEER'S NAME Last Verdo First AW-ky Lic No.
Engineer's Address Engineer's E-mail Address
/106 (4/, /?1, koke, /31ve(. SLti4e A ai,f40 r%jarole
✓
City $,,irdu4< State CA Zip 9/S06 Telephone Ploo- $51- 7091
CONTRACTOR'S NAME/COMPANY San Cuu /3k%biers, Inc Lic. No. SS639? Class
Contractors Address Contractor's E-mail Address
/y22 E Gehryr, Ave. rr�aro{�sat+/urs�ti.;1c%rt. G>W.
City �rr�(�ury State Fz�_ Zip 9toog Telephone 6ac- 9�s s�aS
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $