HomeMy WebLinkAboutX2018-2876 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application °k>
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r Comm'I r Residential Y p rt Beach - Building Division oih
NOTE: PLAN CHFCK FFFR nl Jr: AT Tinnt= no ci ioeniTrni \ �i
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Project Address (Not mailing address) rFlood F_ Fire r Liq r Landslide FN/A Floor Suite No
Description of Work
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# Stories # Units (if Res)F�
Valuation a r
Material/Labor ' � J"
New/Add SFF— Remodel SF
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Garage/New/Add �—�
OWNER'S NAME Last `�(�y t�� �l/(/(,A —vil
First
Owner's Address
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Owner's E-mail Address
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City State CA'
i Zip '%���i° Syr Telephone�'�� ✓j�
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APPLICANT'S NAME Last 0V
First
Applicant's Address
Applicant's E-mail Address
City State �--.
Zip F--- Telephoned—.
ARCHITECT/DESIGNER'S NAME Last
C
First ovi Lic.No. i,vJ'i
Architect/Designer's Addrjjess
Architect/Designer's E-mail Address
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City N,UG%r*- r AzT State
ZiP J�iB6l;,"? TelephoneENGINEER'S
NAME Last (�
First—:4
Lic. No.[ —
Engineer's Address
Engineer's E-mail Address
City State F—'
Zip F_ Telephoned—'
CONTRACTOR'S NAME/COMPANY
I l kic. No. Class
� �J d (—
Contractor's Address
Contractor's E-mail Address
City r—- State �—
Zip �—. TelephoneF_
SETBACKS REAR SETBACKS FRONT
PERMIT NO. X 1, z • W 10
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. W,2 •2D tr�
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $
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