HomeMy WebLinkAboutX2021-2737 - Permit ApplicationPrint ForWorksheet for Combo Building 3 Solar Permit Application k�EWP°Rr
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL �t F�PNP
r—Building [— Grading F—Drainage F_ Elec Mech F—, Plum Cu Yd Cut Cu Yd Fill
Project Address (Plot mailing address) F_ Flood r_ Fire f— Liq [_ Landslide [-.N/A Floor Suite No
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Description of Work
Use Const Type F_
# Stories[— # Units (if Res)F
Valuation $
Material/Labor
—
New/Add SF Remodel SFJ— Garage/New/Add �—
OWNER'S NAME Last First
- ..... .. ____
Owner's Address Owner's E-mail Address
- -... ........ - - --- _..__... --- .
City State �v. Zip Telephone
F ------ ---------- --- - ------- ------------ - - ---- ------- & .... .... ... ............
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
City State �— Zip F Telephone
ARCHITECT/DESIGNER'S NAME Last First F Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State �— Zip Telephone
ENGINEER'S NAME Last First �e Lic. No.
Engineer's Address Engineer's E-mail Address
City State �— Zip Telephone
CONTRACTOR'S NAME/COMPANY 0. Lic. No. t�ri U?, Class
Contractor's Address Contractor's E-mail Address
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Ci �? State Zi Tele honeC.
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SETBACKS REAR SETBACKS FRONT PERMIT NO. f/OM
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $