HomeMy WebLinkAboutPV2021-229 - Permit ApplicationPrint f=orm j Worksheet for Combo Building & Solar Permit Applicationo� m
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NOTE: PLAN CHECK FEES DUF AT TIM nF RI iRMmrrni
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Project Address (Not mailing address) [ Flood f—, Fire [` Liq r Landslide FN/A Floor Suite No
Description of Work
Use Const Type '
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# Stories # Units (if Res)
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Valuation $
New/AddSFF------— Remodel SF Garage/New/Add Material/Labor
OWNER'S NAME Last First
Owner's Address O®wn/1er's E-mail Address
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City StateZip �— Telephone l�C�dl G13� —Z q_q� -
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APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
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State (�i� _ Zip Telephone �3e,.51S 5a
ARCHITECT/DESIGNER'S NAME Last �- First �—
Lic. No: �—
Architect/Designer's Address Architect/Designees E-mail Address
City �— State F— Zip F_- Telephoner
ENGINEER'S NAME Last �� V �n p First �j Lic. No. c7a7 p %
Engineers Address Engineer's E-mail A cess
City State l`� + Zip Telephone
CONTRACTOR'SNAME/COMPANY! Lic.No. �j�1�115 Class cLp�y
Contractor's Address Contrractor's E-mail Address
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City State Zi Tele l
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SETBACKS REAR SETBACKS FRONT PERMIT NO. ✓ j
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. r'
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USE ZONE DEVELOPMENT NO r-1 0
PLAN CHECK FEES $