HomeMy WebLinkAboutX2021-2180 - Permit ApplicationL Print Form_,;] Worksheet for Combo Building & Solar Permii��t/UUA pliccatii,(/o�/n�J Rl�
r Comm'I rX. Residential City of NOTE: PLAN CHECKOrt FEES DUE each - AT TME OF Division
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Project Address (Not mailing address) Ix Flood FX_ Fire JX Liq rX_ Landslide [X—N/A Floor Suite No
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Description of Work
Use F—ConstType F
# Stories #Units (if Res)
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Valuation $
Material/LaborF7s,
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New/AddSF Remodel SF Garage/New/Add
OWNER'S NAME Last M ELK AX
First L4. 1--> i (J&
Owner's Address
Owner's E-mail Address
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City YVfv�\deov. State �C —
zip Gz6..Z _ Telephone T q.S-g55f
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APPLICANT'S NAME Last r1 �
First I � TL74j5 7 Q
Applicant's Address
Applicant's E-mail Address
2
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City .�% ( 5a .Q StateC�
Zip I Z -L _ Telephone /� 3 57-S (g
ARCHITECT/DESIGNER'S NAME Last9�i ,�u/
First / 1 i �� ICZ� Lic. No. r— -- —
�E-mail
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Archhiiteect/esigner's
Architect/Designer's Address
Address ,. /i�U1
city _> State �,
Zip � Telephone qq�
ENGINEER'S NAME Last r �{
First D�Lr_ Ltj��l� Lic No. s �j H
J
Engineer's Address
Engineer's E-mail Address
City State
Zip lam' 1`Z /)� Telephone W • 05
CONTRACTOR'S NAME/COMPANY Lic.No.q 3(ji3� z' Class
�1 i
Contractor's Address
Contractor's E-mail Address
`i Z4 E,1�`/
1 1 d � Gall S ca/� W,
City C05� 1" v`%.J� State F.�
1
Zip 7 2 _TelephoneFT.q,
SETBACKS REAR SETBACKS FRONT
PERMIT NO t� r� ��� �, �� �.f�y%�
it a�
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO t
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $