HomeMy WebLinkAboutX2022-1059 - Permit ApplicationWorksheet^for Combo Bu ildingre SolaDrrPierrmit Applicationl�G
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Description of Work
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Valuation
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OWNER'S NAME Last
First iYrY
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Owner's Address
Owner's E-mail Address
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City I Nev-, 7C'� 1.�dC,(GL
State C Zip -19 /6 I Telephone '-]J� ��,26%
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APPLICANT'S NAME Last
LCi rrCoyl First Se � t
Applicant's Address
Applicant's E-mail Address
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State Zip �Zb z'7 Telephone 3 i0 3 q S � z, I
ARCHITECT/DESIGNER'S NAME
Last L '-CAWFirst
Architect(Designer's Address
Architect/Designer's E-mail Address
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City t �� [� l}�
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State Zip q Z �U S Telephone 7) 6 U Z (�/G
ENGINEER'S NAME Last
First �� No.
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Engineer's Address
Engineer's E-mail Address 1111
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City s[: d tnv
State A_ Zip 1 Z 76,) Telephone �CL 6516"
CONTRACTOR'S NAME/COMPANY
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Contractor's Address
Contractors E-mail Address
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City [GCS i f r
State (' ZiP /� Z 6 L 7 Telephone � IG 3`' _
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $