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HomeMy WebLinkAboutX2021-2112 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Apsion plication Comm'I r,, Residential NOTE: PILAN CH Kty of ort EES UE AT TIME OF uilding iSUBMITT - �/�" 7"fi,z l i z fxBuilding JX_ Grading ,Drainage jX Elec FX_ r' Plum Cu Yd cuts Cu Yd Fill F Project Address (Not mailing address) FX_ J>_� Fire rX Liq FX_ FX_N/A Floor Suite No )gig _ S* '51- F- �-- Description of Work Use F—Const Type F_ # Stories # Units (if Res)s ®t�f 6' t 3 �5- LF 31 �C ��� S Valuation $ Material/Labor t New/AddSFF— _o RemodelSFF—o Garage/New/AddF OWNER'S NAME Last f' u V1, First 9/ Owner's E-mail Address Owner's Addresps� Q City State % Zip F Telephone p P );wt R #qM APPLICANT'S NAME Last (�� (�� y l First _Pwr Applicant's Address Applicant's E-mail Address I (W I t �` fi j j e,v, , eL_r4e, 601 LGI (/ 6, pp�,� City r Los Rr� ��_� State l i t Zip fires) Telephone b ,)b6(j"'�/ 7y v ARCHITECT/DESIGNER'S NAME Last First r F_ Pi Lic. No.F_ Address Architect/Designer's E-mail Address City State F Zip F— Telephones ENGINEER'S NAMEN Last First Lic. No.F_ Engineer's Address Engineer's E-mail Address City I State Zip [— Telephone[ CONTRACTOR'S NAME/COMPANY �� j?j) Lic. No. � SI �', Class `(2 Contractor's Address Contractor's E-mail Address Ci �,* /� Lf State j f� Zi Ty �✓S Ul d �� I �" zip "!sd 7 d� Telephone i� �-�'E�� "�%ly.._.. /V -3 A,� ✓� SETBACKS REAR SETBACKS FRONT PERMIT NO. W 1 SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. 9 USE ZONE DEVELOPMENT NO ''�� //�� q PLAN CHECK FEES$ i2' 8-10