HomeMy WebLinkAboutM2021-0038 - Permit Application.__Print Form Worksheet for Combo Building & Solar Permit Application
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Description of Work
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# Stories #Units (if Res)
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Valuation $ ,
Garage/New/Add �- Material/Labor L I C, C C
OWNER'S NAME Last C6q\2 easy\
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Owner's Address
Owner's E-mail Address
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APPLICANT'S NAME Last First U
Applicant's Address
Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last First Lic. No. I
Architect/Designer's Address
Architect/Designer's E-mail Address
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Zip F Telephoned—
ENGINEER'S NAME Last ��{ t-pv -
-First Lic. No.
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Engineer's Address
Engineer's E-mail Address
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CONTRACTOR'S NAME/COMPANYSh��`Ma
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Contractor's Address
Contractor's E-mail Address
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Zip i� 6�� Telephone 41�C1 S c�Jr3s .
SETBACKS REAR SETBACKS FRONT
PERMIT NO.(/ Vo,� U
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. S -SAA
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