HomeMy WebLinkAboutX2021-2988 - Permit ApplicationI,Lfrl Form'; Worksheet for Combo Building & Solar Permit Application
Comm'I r Residential NOTE: PLAN CHECK ort EES DUE each - BuiAT TME OFing 'sion SUBMITTAL Z`��q `�
Building Grading Drainage Elec F_'Mech I- plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) F_ Flood r Fire -, Liq C- Landslide FN/A Floor Suite No
Description of Work Use F, ' Const Type
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_ i / �� # Stories #Units (if Restl�
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Valuation $
New/Add SFI— Remodel SF1 Garage/New/Add F- Material/Labor7D C7
OWNER'S NAME Last Ito G b per✓fit
� , First
Owner's Address Owner's E-mail Address
City -- --- �� _ - - State C } - Zip I t L y60 . TelephoneF
APPLICANT'S NAME Last
Applicant's Address
City State
First
Applicant's E-mail Address
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Zip - - -, TelephoneE—
ARCHITECT/DESIGNER'S NAME Last First �— Lic. No. �—
Architect/Designer's Address
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city State
Architect/Designer's E-mail Address
Zip Telephone
ENGINEER'S NAME Last First ✓t 5 1n,.t ✓ Lic. No. UU_j
Engineer's Address
- ---._.---------
City k^jr-e k L� State C �-
Engineer's E-mail Address
Zip Telephone
CONTRACTOR'S NAME/COMPANY Lic. No. &(-JZ jab Class
Contractor's Address �f r ` Contractor's 1E -mail Address
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City NPL3 State C �- Zip �2�C1� Telephone `7c(i
SETBACKS REAR I I? SETBACKS FRONT U /
SETBACKS LEFT J
SETBACKS RIGHT S
PERMIT NO. YU74 .9A$1
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FFFR R
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