HomeMy WebLinkAboutX2021-0091 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application oF?
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r NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) r- Flood r Fire r Liq jf Landslide rN/A Floor Suite No
Description of Work
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# StoriesFF # Units (if Res)
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Valuation $
New/Add SF �j Remodel SF Garage/New/Add SG
Material/tabor 140o no
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OWNER'S NAME Last A% AWA IIN First
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Owner's Address Owner's E-mail Address
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APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
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First �— Lic. No. C�?jd4 QjR
ARCHITECT/DESIGNER'S NAME Last �S�
Architect/Designer's Address Architect/Designer's E-mail Address
City State F— ZipF_ TelephoneF_
ENGINEER'S NAME Last j 5 First V L: Lic. No.r�
Engineer's Address Engineer's E-mail Address
I40OD IF ST.
City I fC'A N r N* State I � , Zip CT 27Q 1 Telephone 71 ?¢, $ 3 S�'L MD
CONTRACTOR'S NAME/COMPANY ��S D-evejoy�ml,,,- -'NG Lic No. g12LI77ClassF�
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Contractor's Address Contractor's E-mail Address
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City �cS�4 /�(5� State I Z_A__ Zip gZGZrj Telephone q,{9)2V-GSQ0
SETBACKS REAR SETBACKS FRONT PERMIT NO. X 2,Oz
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. q
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USE ZONE DEVELOPMENT NO ���` d�llto PLAN CHECK FEES $