HomeMy WebLinkAboutXR2022-1959 - Permit ApplicationPrint For
_._ m- Worksheet for Combo Building &Solar Permit Application oF�m
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f wnun 1 1 Residential -•y — NOVdpoi, Ueacn - ouilamg Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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r-Building F_ Grading r-Drainage r-Elec r-Mech Plum Cu Yd Cuts Cu Yd Fill
Project Address (Not mailing address) F Flood r- Fire r' Liq r- Landslide FN/A Floor Suite No
Description of Work
Use s ConstType s
# Storiess # Units (if Res)s
Valuation $
Material/Labor
New/Add SFF_— Remodel SF �— Garage/New/Add �—
OWNER'S NAME Last
First
Owner's Address
Owner's E-mail Address
City State �— -
Zip s— Telephones -
--..-- --- --- _._
APPLICANT'S NAME Last
First
Applicant's Address Applicant's E-mail Address
City State Zip Tele hone
ARCHITECT/DESIGNER'S NAME Last -First[ Lic. No. F—
Architect/Designer's Address Architect/Designer's E-mail Address
City State F— Zip �— Telephoner —
ENGINEER'S NAME Last First Lic. Nos —
Engineer's Address Engineer's E-mail Address
City State F_ Zip Telephone
CONTRACTOR'S NAME/COMPANY C
fir. Y r n^ y Lic No. lQD%�/ Class
Contractors Address Contractor's E-mail Address
city State17-7 — P �Z6 ;G TelephoneF7,!�,�
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $