HomeMy WebLinkAboutX2022-1106 - Permit ApplicationPrint Form -QV sheet for Combo Building & Solar PXm't Appli tion
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NOTE: PLAN FEES DUE AT TIME OF
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Project Address (Not mailing address) F_ Flood r Fire (— Liq andslide rN/A Floor Suite No
Description of Work Wt1A)A SQ— OLDLA
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Valuation $ C)d V
Material/Labor
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OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
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City �J bv GIL/ State r- Zip Z� Telephone
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APPLICANT'S NAME Last �� First i A
Applicant's Address Applicant's E-mail Address
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City � 1�� _ 1 ( �rl State Zip..._ . �1C. 7" Telephon 1149 2�5 4® 41
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ARCHITECT/DESIGNER'S NAME Last � � Lic. No.
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Architect/Designees Address C, /\ F QATrca nees I
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City �� r, State F_ Zip �— Telephone 5X Nl
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ENGINEER'S NAME Last I Pj � � First , /7/v s-- Lic. No. SG30
Engineer's Engineer's E-mail Address
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CONTRACTOR'S NAME/COMPANY jt �d2( Ca ` �ar�, r / «yicNo. �yKy �,t j�Class�
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Contractor's Address Contractor's E-mail Address
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City liAi5 UY�4 ( �CLr State Zip T ZiD Telephone % / / - t�2 �Gi I
SETBACKS REAR SETBACKS FRONT PERMIT NO. e
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE C G i . DEVELOPMENT NO PLAN CHECK FEES $