HomeMy WebLinkAboutXR2022-2764 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application
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NOTE: PLAN CHECK FEES DUE AT TIME ()F Cl IFIRMTrni
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Project Address (Not mailing address) F_ Flood F_ Fire r Liq F_ Landslide F_N/A Floor Suite No
Description of Work
Use 5i Const Type
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# Stories17. # Units (if Res)F—
New/Add SF Lam, Remodel SF t; 2- j�, Garage/New/Add �—
Valuation $ ,l,
Material/Labor t7 0 / 0 ( G
OWNER'S NAME Last t M First S{ e V e
Owner's Address Owner's E-mail Address
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City I"C?W Od State 777Zip 5 Telephone�—
APPLICANT'S NAME Last
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Applicant's Address Applicant's E-mail Address
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City - �� S State
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ARCHITECT/DESIGNER'S NAME Last I First
15h1wn F Lic.No. �—
Architect/Designer's Address Architect/Designer's E-mail Address
City State �— Zip F— Telephoner —
ENGINEER'S NAME Last First FT`—_ Lic No.i( $ —
Engineer's Address Engineer's E-mail Address
—
City State Zip TelephoneF
CONTRACTOR'S NAME/COMPANY Lic. No. �— Class F_
Contractor's Address Contractor's E-mail Address
City State F— Zip F Telephoned®
SETBACKS REAR SETBACKS FRONT PERMIT N0. ui 2 .
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK N0. " ��Nl���
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $