HomeMy WebLinkAboutX2021-0746 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
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EES DUE each - AT TIME OF uilding (SUBMITTAL Vou _ 0716
r'Building - Gra ig niinage r Elec r Mech r- Plum cuvdCut Cu yd Fill
PrOjeCe55 (Not maiQl`ing ad 55) r Flood r FireLiq r La sli N/A Floor Suite No
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Description of Work
Use Const Type
# Stori s Units (if R
V ation a
aterial/Lab
ZOV
New/Add SF Remodel SF ��p`c� Garage/New/Addy
OWNER'S NAME Lash Y y First�V
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Owner's Address Owner's E-mail Address
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City C —1 State Zip rq Telephone qt4 q - (�s-? cfs as
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APPLICANT'S NAME Last t�`/ First
Applicant's Address Applicant's E-mail Address
City- State F Zip F Telephone
A`.RCHI:1`ECT/DEMG NER'S NAME Last I First F F
Lic. No.
Archl4ecUDesigQer'1s1Address Architect/Designer's E-mail Address
Cit State State Zip �� Telephone���-��
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ENGINEER'S NAME' Last I 'jam ^+-1 First EQZi e Lic. No. Q I'_'7 (�j
Engineer's Addreess� Engineer's E-mail Address
R0 7 W � ��1.�j
City � ed1 State Kj� Zip q,; + Telephone
CONTRACTOR'S NAME/COMPANY �h Lic No. F Class
Contractor's Address Contractor's E-mail Address
City I State F— Zip F— Telephone[
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK Nb. y
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $