HomeMy WebLinkAboutX2021-1911 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application Q
r Comm'I j Residential City
�'P��Ne_w h - Building Division
/ NOT � CHEC -ES DU TIME OF SUBMITTAL
wilding r Grading rD nage /Elec r ech�t
Cu Yd CutF Cu Yd Fill
Project Address (Not mailing address) oo� d
� Fire � Liq f` Landslide �N/A Floor Suite No
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Description of Work
Use Ffiw ConstT e —
YP V—�
W. A_
o
# Stories #Units (if Res)
CAAA A�-ej
Valuation
Material/Laa bor
New/Add SF Remodel SF '2. Gara
5v
g F�
a/New/Add I
OWNER'S NAME Last bo�> a)�yw I, --u
First Fpao
Owner's Address
Owner's E-mail Address
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yvao 4eeo6omaw(to ;i)Caec do- ce--A
City CovQre, be-1 „A-(/n r State �
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Zip 9_i 5 Telephone
APPLICANT'S NAME L`ast D
FirstA 0iiiiiii IL
Applicant's Address
Applicant's E-mail Address M
�2,;53 Ek�r� l� f�9e,
jane:J�Es{�.dia. cis
City State I "�
Zip c''(0--+12 Telephone 5(o2. 301.1:;202�-
ARCHITECT/DESIGNER'S NAME Last N;6is First S��I-- Lic. No. G35q o2
Architect/Designer's Address
Architect/Designees E-mail Address
4323 ACCA( j
S(-e mat.! i4mAi o _ e4f
City State
Zip ���.-�y Telephone iji�2_415 t1i
ENGINEER'S NAME Last
First F_ Lic No.[ ---
Engineer's Address
Engineer's E-mail Address
u
City State F_
Zip F Telephoners. V300w i
CONTRACTOR'S NAME/COMPANY
/ Lic. No. O
Contractor's Address
Contracto s E-mail Address
City State F
Zip TelephoneF—
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. G L 7_
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $
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