HomeMy WebLinkAboutXR2024-5184 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
Cit of New ort B h B iId' D'
r Comm'I r Residential y p eac - uing ivision
NOTE, PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F- uilding r Grading rDrainage r Elec r Mech r Plum CuYdCut
F__ cuvdFill F_
Project Address (Not mailing address) F_ Flood r Fire r Liq r Landslide rN/A Floor Suite No
Description of Work
New/Add
OWNER'S NAME
Owner's Address
Use F—ConstType F_
# Storied— # Units (if Res)[ —
Valuation $
Garage/New/Add Material/La
Last �y,',11 -.--_ First 7,OTI
10 SCk10l0_,ej2P //j 0-c-J PC Pt- -
City State I c r'0
APPLICANT'S NAME Last
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Applicant's Address
-7-- 8/c jl— &_ //11 n
City State L E
i`I//so- 0/ie 70- --
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Owners E-mail Address
4 0�v0,_10dEy� a -
Zip J ,�,5y—, TelephoneF—
First / / ! O lLamyy asa
Applicant's E-mail Address
Zip JO S� j Telephone
AKLHITELTWE5IGNEK'5 NAME Last
Architect/Designees Address
City �E�o I e7 State 7. - _
-
First I /no k,,.,,,,, .,. I Lic. No. F—
Architect/Designer's E-mail Address
Zip j� 6 Telephone 0� 3 1r 7,zQ
ENGINEER'S NAME Last S First /�� Lic, No. c
Engineer's Address
_1-130 J_ _vnrL_t<grm� L_A ✓e --
City I yv/FZ State FEA
Engineer's E-mail Address
Zip J/ Telephone �� 22 ,5,00/
CONTRACTOR'S NAME/COMPANY /p�Py Lic. No. Class
�u/lderl �'o2s�zcCf�oi2 �2 C ----
Contractor's Address
1-7
bi
City ;4�-�-V, ego
State
SETBACKS REAR SETBACKS FRONT
Contractor's E-mail Address
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Zip I ,2/ Tc Telephone / „�_3b',05 9y/8
7=70ilM�i ��XAVA!C
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
PLAN CHECK NO.
PLAN CHECK FEES $