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Print Form Worksheet for Combo Building & Solar Permit Application Qa
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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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# Stories7l # Units (if Res)❑
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Valuation $
Material/Labor CIEZD
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RemodelSF�j Garage/New/Add
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OWNER'S NAME
Last 4 First
Owner's Address.
Owners E-mail Address
City State T p ��. .. i�U Telephone.
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APPLICANT'S NAME
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Applicant's
Applicant's E-mail
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ARCHITECT/DESIGNER'S NAME —�
Last �— Firsti Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address _
City
State � Zip LJ Telephoned
ENGINEER'S NAME
Last I First t�— Lic. No.�
Engineer's Address
Engineer's E-mail Address
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City
StateZip Telephone
CONTRACTOR'S NAME/COMPANY Lic. No. (,i. ,1 (q ,Class �r
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Contractor's Address
Contractor's E-mail Address
City
State i Zip tL Telephone
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SETBACKS REAR
SETBACKS FRONT PERMIT NO. (%zi
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.moi_ 7 I
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $