HomeMy WebLinkAboutXR2022-3216 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Ap llcation
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NOTE' PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Description of Work
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Valuation
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OWNER'S NAME Last �%Lo4o
First �UF'
Owner's Address
Owners E-mail Address
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APPLICANT'S NAME Last ��//
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.Applicant's Address
Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last First F-- Lic. F-_
No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City State r—�
Zip �-- Telephone_
ENGINEER'S NAME Lasi 11Y'1''
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First '%�AN,t)F1.r,L Lic. No,��
Engineer's Address
Engineer's E-mail Address
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CONTRACTOR'S NAME/COMPANY l
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Contractor's Address
Contractor's E-mail Address J
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SETBACKS REAR SETBACKS FRONT
PERMIT NO. I ! lF
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NOT(
USE ZONE
DEVELOPMENT NO
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