HomeMy WebLinkAboutXC2022-1877 - Permit ApplicationFret Form_ Workshaet for Combo Building & Solar Permit Application
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Project Address Not mailing address) ❑ Flood ❑ Fire ❑ Liq ❑ Landslide (fl/A Floor 111 Suite No
Description of Work b 1
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OWNER'S NAME Last s tiKVfNk� �,�.{p�%ty First _----�
Owner's Address Owner's E-mail Address
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APPLICANT'S NAME Last �/� Jv� First !
Applicant's Address Applicant's E-mail Address
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City State Cj'� i Zip lZy7! Telephone 2•-_-`T)ij>p
ARCHITECT/DESIGNER'S NAME Last (/jam U�.h I I Ftrstt f
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Architect/Designer's Address Architect/Designer's E-mail Address
----1I!--- State Zp zj,6U1 Telephone
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ENGINEER'S NAME Las[ First Lic No.
Engineer's Address Engineers E-mail Address
City _ State I Zip I Telephone---
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CONTRACTOR'S NAME/COMPANY U� P' 11j
- -- Lic. No. (�� L4 Class _
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Contractor's Address Contractor's E-mail Address
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City �S �_ -__.. State ! / ! j Zip1�— Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO. xC 20n_ 87 7
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. f C uzz - 1$y
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $