HomeMy WebLinkAboutXR2023-0349 - Permit ApplicationPrint Form Worksof
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for Cdinbo`Buildirtg & Solar Permit Application (1,(,
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Project Address (Not mailing address) F_ Flood j- Fire F Liq F_ Landslide A Floor Suite No
Description of Workr�
Use ConstTyp`
# Stories[ # Units (if RW
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Valuation
abor
Material/La
New/Add SF Remodel SF F— Garage/New/Add
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OWNER'S NAME Last
Owner's Address \_.S Owner's E-mail Address
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APPLICANT'S NAME Last GL./zt�E First �1 c \
Applicant's Address Applicant's E-mail Addre`sssAI
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ARCHITECT/DESIGNER'S NAME Last -T� � Firs�� —Lic. No.
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Architect/Designer's Address Architect/Designer's E-mail Address
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ENGINEER'S NAME Last First �Z � Lic. No.0 )$�3L
—Engineer's Address Engineer's E-mail Address
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CONTRACTOR'S NAME/COMPANY� Lic. No. Class
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Contractor's Address Contractor's E-mail Address
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SETBACKS REAR j ( SETBACKS FRONT PERMIT NO. (!��� ""lam' ✓`!� -�
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I f 1 r/ PLAN CHECK
SETBACKS LEFT ��/ SETBACKS RIGHT � �7
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $�L-'