HomeMy WebLinkAboutX2020-2657 - Permit ApplicationPrint Form Works)4eet for Combo Building & Solar Permit Application o�E °Rrm
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL / .•
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Project Address (Not mailing address) F_ Flood
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Description of Work
Use Const Type
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Valuation $
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OWNER'S NAME Last l� t^e 1
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Owner's Address
Owner's E-mail Address
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City Neu✓ 1-)u'- State L. }
Zip I Telephone 7/c{ - 9re r- U S ��
APPLICANTS NAME Last J D) l 15c-"'-�
First
Applicant's Address
Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last First F �®
Lic. No.
ArchitecUDesigner's Address ----.
ArchitecUDesigner's E-mail Address
City F State
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Zip -� Telephone I vor
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ENGINEER'S NAME Last
Firs . N &A ri _ Lic. No.F-
Engineer's Address
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Engineer's E-mail Address
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City State F Zip F Telephoned'
CONTRACTOR'S NAME/COMPANY Cw -
, R id�l Class
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Contractor's AJddress
Contractors E-mail Address
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City (( /( (fir(. State Zip 177 77, Telephone
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SETBACKS REAR SETBACKS FRONT
PERMIT NO. •
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $