HomeMy WebLinkAboutXR2023-2861 - Permit Applicationr�°°R
Print Form Worksheet for Combo Building & ISolarPeermit Application U0.a
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
(Building j—Grading [—Drainage FElec KMech
R Plum CurdCut F CuvdFill
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Project Address (Not mailing address) [- Flood
[- Fire r Liq [- Landslide FN/A Floor Suite No
37q N ti;��,r r h��� C;
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Description of Work
Use F ConstType�
# StoriesFT # Units (if Res)F_
Valuation
Material/Laa bor
`t
New/Add SFMaterial/Labor
L l (J Remodel SF �, � L� Garage/New/Add � (�
OWNER'S NAME Last (n
17 I "v v First
Owner's Address
Owner's E-mail Address
974 iJIGWCC(=f
H( 1P,'—'V_)JN5_3c(grVIN1— c i;,�,
City ; ( State
NEv%p(wT AC (� I [ A
Zip Fq Z4j�G Telephone q�
APPLICANT'S NAME Last tfo(First JEyc /l
! I (l l (L 1-1 P� � C—
Applicant's Address
Applicant's E-mail Address
i i �y WEST S I
/-�D,vrz + pYIJ �C i�p.1f �v C-0 ,
City SAN'l-A State
Zip gZ/03 Telephone 7/ J-G i5-7S L'
ARCHITECT/DESIGNER'S NAME Last
First E-5-Z 1-7 � Z Lic. No.
Architect/Designees Address
Architect/Designer's E-mail Address
Z05&1 '5,A5w.rL91A LI,)
Di�5isr jvlr—v_ S CC>AA
City SFA(, H State C_
Zip q_ y Telephone •7/ C1- c�� 3— y c, G
ENGINEER'S NAME Last `Jrph9.`S
First � (� L � Lic. No. "7
l 5U` L
Engineer's Address
Engineer's E-mail Address
f' (�it1
C-5I CL'l
City 5�1�17� A1--�A State CA
Zip �72jf Telephoneff/U-V
CONTRACTOR'S NAME/COMPANY a�N�i�il i �oNSI ULT( N 11C^Y✓I�Lic.No.'' 1i0iu( }(3 Class �7
Contractor's Address
Contractor's E-mail Address
iI(q U' >1 t
G
(4or.Ey ,,TT/YIki'C"��/��IL-e v.1�
City `? 111V —,A AN 6 State (` A
Zip �j 2 U 3 Telephone 7.!
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $