HomeMy WebLinkAboutXR2023-2459 - Permit Applicationrt Beach -
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NOTE: PLAN CHECKOFEES UATTIMEOF (SUBMITTAL Print Form_ Worksheet for Combo BuildingE & Solar Permit Application E POa
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F_ Building Grading rDrainage r Elec F—VAech F Plum CuYdCut CuYdFill F
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Description of Work
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Valuation $
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OWNER'S NAME Last
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Owners Address
Owner's 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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State ch, Zip qi�4_ Telephone `W`T-zA63-Z--+6a
ARCHITECT/DESIGNER'S NAME
Last Ley �� C 1n�J0.1�L{/1� First L( �fl Lic. No. �—
Architect/Designer's Address
Architect/Designer's E-mail Address
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State I� Zip T&I-} Telephone C�({q
ENGINEER'S NAME Last
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Engineer's Address
J Engineer's E-mail Address ZAP qO l7.
City I
State F_ Zip F TelephoneF_
CONTRACTOR'S NAME/COMPANY Lic. No. F-- ClassF
Contractor's Address
Contractor's E-mail Address
City I
State F— Zip F— Telephoned
SETBACKS REAR
SETBACKS FRONT PERMIT NO. 5
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. l '1-6 1/;�• "Zj SW
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $ ) G12. . `i /�,