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Pani Form W heet for Combo Building & Solar Permit Application oF��"°
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL c<-.�.�"
❑Building ❑ Grading
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Project Address (Not mailing address) ❑ Flood ❑ Fire ❑ Liq ❑ Landslide ❑N/A Floor Suite No
Description of Work
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# Stories # Units (if Res)
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OWNER'S NAME
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Owner's Address
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Owner's E-mail Address � 6 V/�%
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APPLICANT'S NAME
Last•+ I V RiZ� J First
Applicant's Address
Applicant's E-mail Address
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State Zip oGi(� Telephone Ql.[ - -3 �(e
ARCHITECT/DESIGNER'S NAME Last I aw r�-�1First Lic. No.
Architect/Designer's Address
Architectinesigner's E-mail Address
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City
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State [E� Zip Q Telephone
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ENGINEER'S NAME
Last Lic. No.�L
Engineer's Address
Engineer's E-mail Address
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CONTRACTOR'S NAME/COMPANY �t3� 1 Lic. No. 007d6 i/ Class r7e
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Contractor's Address
Contractor's E-mail Address
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State � C� P zJ-uG i Telephone
SETBACKS REAR
SETBACKS FRONT PERMIT NO...
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. 901
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $ v 141