HomeMy WebLinkAboutX2019-2139 - Permit Application1. Print Form o I Worlfet for Combo Building &Solar Permit Application o4°
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Description of Work
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Valuation$ 15,000
ValuationMaterial/$ or
New/AddSF�— �32
Remodel SF / Garage/New/Add �—
OWNER'S NAME Last
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Owner's Address
Owner's E-mail Address
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APPLICANT'SNAME Last
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Applicant's Address
Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME
Last First � Lic. No. �—
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State �— Zip F— Telephone�—
ENGINEER'S NAME Last
First F—Lic No.F--
Engineer's Address
Engineer's E-mail Address
City
State �— zip I Telephone�—
CONTRACTOR'S NAME/COMPANY�cA4
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Contractor's Address
Contractor's E-mail Address -7
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REAR
SETBACKS FRONT PERMIT NO. I
LEFT
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[VS
SETBACKS RIGHT PLAN CHECK NO.
DEVELOPMENT NO PLAN CHECK FEES $