HomeMy WebLinkAboutX2016-4029 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL °�•o•+s
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Project Address (Not mailing address)lood F- Fire rxLiq r Landslide rN/A Floor Suite No
Description of Work XXI!j 2 :f7�7 2
Use Il'"�LV Const Type
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# Stories # Units (if Res)K
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Valuation $ qI
Material/ bo / `M
New/Add SF .) R model SF N �{ : Garage/New/Add
OWNER'S NAME Last
First Ywelcl�
Owner's Address
Owner's E-mail Address
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City State F—
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APPLICANTS NAME Last
First
Applicant's Address
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Applicant's E-mail Address
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City 40WrA.A State �
Zip Telephone c� 7-1f
ARCHITECT/DESIGNER'S NAME Last First I �j Lic. No. C/3 S/l0
Architect/Designer's Address
Architect/Designees E-mail Address
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Zip 'TCaZ.L Telephone jj�6 ?4 -17400
ENGINEER'S NAME Last f
First j�/(yyf j� (� Lim. No. C -f &Z 0
Engineer's Address
Engineer's E-mail Address
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City Y7�i1~Ca�GIf} State
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CONTRACTOR'S NAME/COMPANY�5
Lic. No. 5 4 `� (� I Class
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Contractor's Address
Contractor --mail Address
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City � (� - _ _-- _ State �\
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SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. / p 3`,- �� L
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $ -t 5 f, • _I b .