HomeMy WebLinkAboutXR2023-0632 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permeachsionit ApplicationCity of @Awsi�
r Comm l Residential NOTE: PLAN CHECKOFErt ES DUE AT aIME OF ing ISUBMITT���-v63� 9
F-Building r Grading [ -Drainage F_Elec FMech F` Plum Cu vd Cut Cu Yd Fill
Project Address (Not mailing address) F_ Flood r Fire F_ Liq r Landslide FN/A Floor Suite No
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Description of Work
Use F_ Const Type
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# StoriesF- # Units (if Res)[_
New/Add SFF Remodel SFF Garage/New/Add F—
Valuation $ _
Material/Labo
OWNER'S NAME Last First L—pl �y
Owner's Address Owner's E-mail Address
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City Z_?,Po - /5 (i State c 14- Zip Telephone iZ%i-956-
APPLICANT'S NAME Last z First S C TT
Applicant's Address Applicant's E-mail Address
City State c A Zip Telephone % / y 7 Yc g� l
ARCHITECT/DESIGNER'S NAME Last First 7 Lic. F—
No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State F Zip Telephone�—
ENGINEER'S NAME Last First Lic. No.r_—
Engineer's Address Engineer's E-mail Address
City State Zip �— Telephoner
CONTRACTOR'S NAME/COMPANY Lo 6lv�- E)13 p- Lic. No. 1po7`i3 7 Class d-` 17
Contractor's Address J Contractor's E-mail Address
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City T2-C/yN C State Z:A- Zip lJ')(/y Telephone 7/V 2Y�-�,��
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $