HomeMy WebLinkAboutXR2024-6774 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) r Flood r Fire r Liq r Landslide rN/A Floor Suite No
Description of Work c(—_y4w9At' /2f e' Z 7✓2-ia lerIL
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Valuation $�� Cr
Material/Labor
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OWNER'S NAME/CoQ6. <' Ay — F rr-R P,A%`� yZ'7Y �(r
Owner's Address Owner's E-mail Address
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City �L j//�(/� State rA Zip -2Z%p/' Telephone 99,v--7.2,-,7
APPLICANT'S NAME Last ��j JL (�/4 X First y/
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Applicant's Address Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last Z- A7L' First �Lic. N "---2¢�3_
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Arch itect/Designer's Address Architect/Designer's E-mail Address
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City State ZID Te-"" lephonoF—
ENGINEER'S NAME Last First F_ Lic. No.F_
Engineer's Address Engineer's E-mail Address
City State F_ Zip F_ TelephoneFI--
CONTRACTOR'S NAME/COMPANY Lic. No. ClassF
Contractor's Address Contractor's E-mail Address
City State F Zip F_ TelephoneF—
SETBACKS REAR SETBACKS FRONT PERMIT NO. yCR2OZy-�% y
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $