HomeMy WebLinkAboutX2019-2128 - Permit Applicationartnt> orrn., Worksheet for Combo Building & Solar Permit Application
(- Comm'[ Residential NOTE: PiLAN HECKty of OFEES DUE rt Beach - AT TME OF ing Division
- " `r' size u° �
F-Building. r Grading r"Drainage FElec FMech [ Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address)
I� Flood f- Fire I- Liq andslide f /A Floor Suite No
Description of Work
Use F_ ConstType
# Storie # Units (if Res)
Valuation $
Ne Add SFJ Remodel SFr Garage/New/AddF _ Material/Labor
OWNER'S NAMEL st j
Owner's Address L Owl"s EmaitAddrs `
K
City P ew i Zip Telephone17,
L ( ��
APP NT'S NAME Last First
Applicants Address Applicant's E-mail Address
City � State F_ Zip F_ Telephonel-_-_
ARCHITECT/DESIGNER'S NAME Last First F _-_---�
Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State F_ Zip I TelephoneF
ENGINEER'S NAME Last First Lic. No.r
Engineer's Address Engineer's E-mail Address
City State � Zip =�_-- TelephoneF—�
CONTRACTOR'S NAME/COMPANY Lic. No. F ' Class
Contractor's Address Contractor's E-mail Address
City - State F Zip I - — Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO. < � r
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. t,_} i L� O t
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $