HomeMy WebLinkAboutX2022-1401 - Permit ApplicationPrint Form I Wow eet for Combo Building & Solar P uilic'A
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NOTE: PLAN CHECK FEES DUE AT TIME OF SU °�opN
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Project Address (Not mailing address) Flood Fire r, Liq Landslide Suite No
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Description of Work
Use onst Type
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# Stories # Units (if Res)',
Valuation $
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OWNER'S NAME Last` TCM4 First
Owner's Address Owner's E-mail Address
City ' } ...-"..... . .State Zip �.> phone
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APPLICANT'S NAME. 'A �
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Applicant's Address Applicant's E-mail Address -
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ARCHITECT/DESIGNER'S NAME Last 1 n/ 1 �r First
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Architect/Designer's Address Arch itect/Designer's E-mail Address
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ENGINEER'S NAME L2 t�7 First jj�� ; Lic. No
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Engineer's Address Engineer's E-mail s
City State l Zip Telephone��
CONTRACTOR'S NAME/COMPANY , n /�� Lic. No. Class'
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Contractor's Address Contractor's E-mail Address 107 BdZU
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City
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SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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