HomeMy WebLinkAboutX2021-2973 - Permit ApplicationPrint Form _] Worksheet for Combo Building & Solar Permit Application
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rBuilding F_Grading F-Drainage [Elec F_Mech F-Plum cu vd cut Cu Yd Fill
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Project Address (Not mailing address) [_ Flood F- Fire F_ Liq F_ Landslide 1-N/A Floor Suite No
Description of Work
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Valuation
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OWNER'S NAME Last - �[ First � 5
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Owner's Address Owner's E-mail Address
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APPLICANT'S NAME Last C,�'J IAFirst 1m
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ARCHITECT/DESIGNER'S NAME Last First Lic. No. �—
Architect(Designer's Address Architect/Designer's E-mail Address
City State �— Zip �— Telephonel—
ENGINEER'S NAME Last N A M&RlAkp, A) I First FkjN(4kA) Lic. No. F05; 70
Engineers Address Engineers E-mail Address
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CONTRACTOR'S NAME/COMPANY j�od,4� % Gf h rl f �/i1� Lic No. jr5 3q(p4 Class
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Contractor's Address Contractor's E-mail Address
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SETBACKS REAR SETBACKS FRONT PERMIT NO. � p ,) — _uC1 -7 `
JE I BACK) LEh I SETBACKS BACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $