HomeMy WebLinkAboutXR2023-0008 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application NO
Comm'I F_Residential sion
NOTE: PILAN CHEKty of o EES DUEAT TIME OF rt Beach - Building (SUBMITTAL
[—Building rGrading rDrainage FElec Mech
7Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) F_ Flood F_ Fire F_ Liq F_ Landslide F_N/A Floor Suite No
Description of Work
Use F—ConstType F_
# Stories # Units (if Res)[
Valuation$
Material/Labor
New/Add SF�— Remodel SF�— Garage/New/Add F—
OWNER'S NAME Last First
Owner's Address
Owner's E-mail Address
City �JA, q State !_p°t
Zip iJi/Jf1 Telephone
APPLICANT'S NAME Last
First � �. ✓ i L-,.� _
Applicant's Address
Applicant's E-mail Address
City 1 T ; ,�_ <' v U i !f v State 1 '
p LL2 I (
Zi 77 �/ Telephone L Ctt' I- 7�
ARCHITECT/DESIGNER'S NAME Last
First �— Lic. No. �—
Architect/Designer's Address
Architect/Designer's E-mail Address
City State F_
Zip F Telephoner
ENGINEER'S NAME Last First Lic NoF
Engineer's Address
Engineer's E-mail Address
City State
Zip F TelephoneF—
CONTRACTOR'SNAME/COMPANY
Lic. No. vClassF
Contractor's Address
Contractor's E-mail Address
City State
Zip Telephoned ,®
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKSLEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $