HomeMy WebLinkAboutXC2024-0412 - Permit ApplicationPrint Form 1 Worksheet for Combo Building & Solar Permit Application ?EW°°R.
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Project Address (Not mailing address) r Flood _ Fire f Liq r Landslide rN/A Floor Suite No
Description of Work
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# Stories # Units (if Res)F—
Valuation $ j
Material/Labor FT)�I
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OWNER'S NAME Last
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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
City State—
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ARCHITECT/DESIGNER'S NAME Last �
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Architect/Designer's Address Architect/Designer's E-mail Address i
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ENGINEER'S NAME Last First F_ Lic. No.F�
Engineer's Address Engineer's E-mail Address
City State �— Zip F TelephoneF —
CONTRACTOR'S NAME/COMPANY o f>f��r jt- Lic. No. F— Class
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Contractor's Address
Contractor's E-mail Address
City State �— Zip F_ TelephoneF�
SETBACKS REAR SETBACKS FRONT PERMIT NO. � 12
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
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