HomeMy WebLinkAboutX2020-2579 - Permit Application1=rmt Form ,� Worksheet for Combo Building & Solar Permit ii
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TE: PLAN CHECK FEES DUE AT TIME OF SUBMITT Q
[Building ['Grading rainage ❑Flet [IMech
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Project Address (No address)
[I Fire [I Liq rl Landslide [N/A Floor Suite No
Description of Work `
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#Stories # Units (if Res)F
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New/Add SF Remodel SF
Valuation $ V V
arage/New/Add Material/Labor
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OWNER'S NAME Last
First
Owner's Address
Owner's E-mail Address
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City S�(Y
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APPLICANT'S NAME Last
First
Applicant's Address G vv�
Applicant's E-mail Address
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City State �...__li
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Zip CTTelephone
ARCHITECT/DESIGNER'S NAME Last -
-- First -- Lic. No.
Architect/Designees Address
Architect/Designer's E-mail Address
City State
Zip—I Telephone—I
ENGINEER'S NAME Last First Lic. No.
Engineer's Address
Engineer's E-mail Address
-
City State
- -
Zip �^� Telephone
NAME/COMPANY
Lic. No F777 Class
CONTRACTOR'S
Contractor's Address
Contractor's E-mail Address
Cit State �—
Zip Telephone�7�d
SETBACKS REAR SETBACKS FRONT
PERMIT NO. U
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $