HomeMy WebLinkAboutXR2023-1552 - Permit Applicationrur n I Worksheet for Combo Building & Solar Permit Application
I- Comm'I F Residential City of New
NOTE: PLAN sion
CHECKo EKES DUE ATeach - ITIMEE DF ICi llphmi ,
Buildll
777
Description of Wnd.
New/Add SFF
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OWNER'S NAME
Owner's Address
City
APPLICANTS NAME
Applicant's Address
I Drainage r Elec F Mech
I- Plum Cu vd cuts
address) t mailing addrf Flood
) (— Fire j- Liq j- LandclfHo
s�'aU /e t.,/
Cu Yd Fill
I -N/A Floor
Ise [_ Const Type �—
Stories # Units (if Res)s
Remodel SF I (Z� S ff Garage/New/Add �— Val n 5
Materia or ZG; GUG�
Last
First
c— n
Owner's E-mail Address
State s---- G"' ' /C)J"
Zip Telephone --
Last
Applicant's E-mail Address
City
r
State F — Zip �—
ARCHITECT/DESIGNER'S NAME Telephone--
Last
ArchitecVDesigner'sAddress Z-y First --
6 /ry c ,— Lic. No. �—
Architec� -Designer's E-marl Address
City I
State �— Zip F
Telephone
ENGINEER'S NAME
Last
G L% l First
Engineer's Address � i yypp
Engineer's E-mail Adll a o
City I I
State F- Zip f,
Telephone
Lic No.F —
CONTRACTOR'S NAME/COMPANY
Contractor's Address Lic No. s---- Class
Contractor's E-mail Address
City
State Zip F, Telephones --
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SETBACKS REAR I=— SETBACKS FRONT
SETBACKS LEFT
USE ZONE
— SETBACKS RIGHT
—�
DEVELOPMENT NO
PERMIT NO. k-e,�V23 _/ b 5�
PLAN CHECK NO. /iiaDo?�/
PLAN CHECK FEES $