HomeMy WebLinkAboutX2021-3061 - Permit ApplicationFruit Form _ Worksheet for Combo Building & Solar Permit Application
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NOTE: PLAN,CHECK FEES DUE ATrt Beach - ITIME OFlding SUBMITTAL
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F Comm I Residential City of
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Project Address (Not mailing address) F_ Flood F— Fire F_ Liq [_ Landslide rN/A Floor Suite No
Description of Work
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New/Add SF 0 Remodel SF $('�s�' Garage/New/Add F
Use F; Const Type F_
# StoriesF_ # Units (if Res)F_
Valuation $
Material/Labor 010�
OWNER'S NAME Last ,�b Off First sAew
Owner's Address Owner's E-mail Address
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City Corr-ti Qv( ��_ _.. State ZiP '12 (,2s Telephone 2-T
APPLICANT'S NAME Last First S
Applicant's Address Applicant's E-mail Address
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City G�State FTZiP Telep
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ARCHITECT/DESIGNER'S NAME Last First
Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State F Zip Telephone
CONTRACTOR'S NAME/COMPANY Lic. No. q p371V_ , Class
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Contractor's Address Contractor's E-mail Address
City p� �r �S� State I "' ` Zip 2-626 Telephone q Y 4 -- H y .- `W o
SETBACKS REAR SETBACKS FRONT
PERMIT NO. 4 11CI 1- c,5L7
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $