HomeMy WebLinkAboutXR2022-3200 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application
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Comm'( Residential NOTE: PLAN CHE KOF E S DUE AT TIIOF IME (SUBMITTAL �32W
/Iuilding F_ Grading ("Drainage —/,Iec F_Mech F/11 um cuYdCut F_ CuvdFill F_
Project Address (Not mailing address) C Flood F_ Fire F_ Liq r Landslide F_N/A Floor Suite No
15-6 zo/pta4)r[IG j. kk� ct be-vek cC./Jr. '7066 F_ ( —
Descr�riiptionofWorkr
User ConstTyper
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# Storiesr #Units (if Res)r
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Valuation $
Material/Labor
New/Add SF�— Remodel SFr— Garage/New/Addy—
OWNER'SNAME Last CYLlil�2C{G�Y First
Owner's Address Owner's E-mail Address
160 Vj 6764Cijf 4a
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City L9 State �� tl Zip Fff_,&- TelephoneF_
APPLICANT'S NAME Last ��j J-1 First
Applicant's Address Applicant's E-mail Address
(�t,6 te- Avg `-et1/scab pac6e—((,he
CityFora State O Zip Telephone F 4734
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ARCHITECT/DESIGNER'S NAME Last e First 7 Lic. No. I
Architect/Designer's Address Architect/Designer's E-mail Address
City State F— Zip F TelephoneF_
ENGINEER'S NAME Last (�%�v(t ( First fir( Lic No. L(
Engineer's Address Engineer's E-mail Address
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City State �jA Zip qc Telephone �ll �—wr T.p(�
CONTRACTOR'S NAME/COMPANY_cGl�� Lic No. � Class
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Contractor's Address Contractor's E-mail Address
(4(,' &, 60(vga- 9vic, �Wl _ca(o�
City f �a State G� Zip `�qi Telephone 11Y_W68_ y�5
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $