HomeMy WebLinkAboutX2018-2470 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application o;FWo�R>a
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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ProjectAddress r W,, Fire 71Liq r, Landslide F)iN/A
(Not mailing address) Flo Suite No
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Description of Work ✓3 W
Use b-'ConstType
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# StoriesF # Units (if Res)r—
Valuation $
Material/Labor 2
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New/Add SF�' Remodel SF I"l`I� Garage/New/Add
OWNER'S NAME Last 6�',�i First '�Sfr �'M
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Owner's Address Owner's E-mail Address
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City N-� �. StateI (j Telephoned
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APPLICANT'S NAME Last ! First
Applicant's Address Applicant's E-mail Address
ZX03L 741-MCM
City State Zip l�� Telephone
ARCHITECT/DESIGNER'S NAME Last. SAAS ,4fj1G10Nrv! First Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
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City State ZipTelephone
ENGINEER'S NAME Last Il/.. 1 First Lic. f3��'
Engineer's Address Engineer's E-mail Address
I � Z � C 1%Fla�danJ �✓� S � jJ II
City O ,rJ�' State I V Zip qi 666 - Telephone ` W- ?V—RZb
CONTRACTOR'S NAME/COMPANY Lic. No. 69iGU� 'Class
Contractor's Address Contractor's E-mail Address
zb� 3� 734 Y� 64SCJIA/G19-571?,rxI.�84L.���
City r ! State I 0Zip z t Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO. ) Z+2I 1�'+
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. i DLO
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $ i i"I ` % �-k O