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Print Form Worksheet for Combo Building & Solar Permit Application
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) (- Flood (— ire [ Li Landslide [-N/A Floor Suite No
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Description of Work Use ConstType
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# Storiesi � # Units (if Res)
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v Valuation $
New/Add SF7-7—� Remodel SF177777 Garage/New/Add rJ Material/La
OWNER'S NAME Last I r,14ZI5 `'(A4e5 First
Owner's Address Owner's E-mail Address
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City a 1,¢.l Mptc State Zip alifjzs Telephone �i�ii f��jzS
APPLICANT'S NAME Last
Applicant's Address
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City - )-AA,hi }q oA —� State
First
Applicant's E-mail Address
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Zip y� '. Telephone _ 515 eZ
ARCHITECT/DESIGNER'S NAME Last Firstj Lic. No.
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Architect/Designer's Address ArchitectIDesigner's E-mail Address
City State Zip L Telephone
ENGINEER'S NAME Last _ - - _ First I i Lic. No.
Engineer's Address
City - State—!
Engineer's E-mail Address
Zip F Telephone[ ;
CONTRACTOR'S NAME/COMPANY __II __� �� !� Lic No. a41t5 Class�L{�
Contractor's Address
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City �. �? E State ��+,pp
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SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
Contractor's E-mail Address
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Zip ClZ6'y!p Telephone r. i_ 44-1 4 Z I
PERMIT NO. Vj�"-#Qvy—
PLAN CHECK NO. 10 3-4 ' '-•a'LO
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $