HomeMy WebLinkAboutXR2024-6975 - 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) [_ Flood r Fire r Liq r Landslide FN/A Floor Suite No
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Use F� ��
Z Const Type �
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# Stories'F'/ #Units (if Res) �'
Valuation$ _ �C�
Material/Labor GJ?
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Owner's Address( E-mail Address
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APPLICANT'S NAME Last T12- A le- First I ,Ay
Applicant's Address Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last Z ,,a_/ First - 2--
Architect/Designer's Address Architect/Designer's E-mail Address
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City ip Telephoned
ENGINEER'S NAME Last First Lic. No.F
Engineer's Address Engineer's E-mail Address
City State F Zip F TelephoneF
CONTRACTOR'S NAME/COMPANY L Et t i ( Lic No. = (S Z' V ; y ClassF
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Contractor's Address Contractor's E-mail Address
City State F Zip I Telephone[
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK Ni.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $