HomeMy WebLinkAboutXR2022-3105 - Permit ApplicationPnntForm
Worksheet for Combo Building & Solar Permit ApPiication
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[Building
P each - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL_
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Project Address
Description of Work
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New/Add SFs�— Remodel SFs�—
UwrvtK'5 NAME
Last
Cu Yd Cut Cu Yd Fill
r Fire [- Liq [- Landslide [_N/A
Floor Suite N
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Use Const Type
# Stories # Units (if Res)r
Valuation $
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Applicant's Address First
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ARCHIT � , Telephone-
/DESIGNERS NAME / - --
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Architect/Designer's Add - - -
ress /
City F C�
ENGINEER'S NAME
Last
ngineer s Address
City
State �®
C. No.
Architect/Designer's E-mail Address
Zip {�relephone
First Lic. No.
Engineer's E-mail Address
Zip s——
TelephoneF
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CONTRACTOR'S NAME/COMPANY /
Contractor's Address
City V7 State
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SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT
SETBACKS RIGHT
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Lic. No. l Class
Contractor's E-mail Address
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Zip 7 - - - -- - -
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PERMIT NO.
PLAN CHECK No. 1r,,6 2cvZ 7