HomeMy WebLinkAboutX2022-1689 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBM
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Project Address (Not mailing address) F_ Floodr Fire F/ LLiq F_ Landslide f N/A Floor Suite No
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Description of Work
Use Const Type s
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# Stories # Units (if Res)s
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New/Add SF Remodel SF s— r
Garage/New/Add I
Valuation $
Material/Labor
OWNER'S NAME Last ��,-�� First
Owner's Address
Owners E-mail Address
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APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City State Zip �— Telephones—
ARCHITECT/DESIGNER'S NAME Last L7Wjlit First J�?���� Lic.No.�—
Architelc/t/Designe�r's Address Architect/Designees E-mail Address
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CityE_Fz:��h' State Zip Telephone " )
ENGINEER'S NAME Last 7
First 2F Lic. No.F--
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Engine(e�r'sA/ddress
Engineer'sE-mail,(A1(d1'dress
_ Telephone
City ' um�✓Cc._ State Ch Zip c/
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CONTRACTOR'S NAME/COMPANY Lic. No. �— Classs
Contractor's Address Contractor's E-mail Address
City State �— Zip F— Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO. X !2 D7 2i t CG M
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. is�v-%.fi%y
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $