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HomeMy WebLinkAboutX2019-0756 - Permit ApplicationCE PTlForm Worksheet for Combo Building & Solar Permit apion AR e 0 U/�� /� Iia on Comm'I Residentia `4— VIV anyofvwporeac- �uuomg uiwsion 6 - NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL fS(Building r Gradin Drainage \ ElecTech Plum cuvdcutF cuvdFill F /Project Address (Not mailing address) F Flood Fir Li Landslide F_N/A Floor Suite No i8zs v � vvd. 14�, �d+ ?e zW/43 Description ofMo G" Use F—Const Type F_ ra # Stories # Units (if Res)' ¢ ` `nUm T f 1 ` f 3/ &46)4. -bc&r0.YA11-y\41 VVD'rI� 1i �E Valuation $ New/Add SFI Remodel SF t 1 6 Garage/New/Add �� Material/Labor OWNER'S NAME Last�1� I y rel �n First JOwner's Owner's Address E-mail Address 1S w. Q�C6r (,a4 ;tsyC�2ouaa1�12�c CRY N r State I L FI !3 � Vr� Zip Telephone �r®... r����j���'% f APPLICANT'S NAME LastFirst Applicant's Address Applicant's E-mail Address / I 2Zloj G0.`�yDtil � � ,(� T �radlCt�S�rt�G�iiY Id(c5l/G��11 u u!_otvj City a> S 1 CA J V t � i State Zip � Telephone _ /7& ?2,0 l�"/ ARCHITECT/DESIGNER'S NAME Last First � Lic. No. y�c1t Architect/Designer's Address Architect/Designer's E-ma'idress L7MYAvCoj 0.�rjlji1rA ILOS ��/�YGi. City State` Zip 7 Telephone ( D ENGINEER'S NAME Lastr' C FirstLic. No.FZZEEff Engineer's Address Engineer's E-mail Address - %raA�n G.t9 S'j'YVt'tJrq I �rc� I` yt t V✓tdl( l • e Po M City'CYb State Zip �� Telephone CONTRACTOR'S NAME/COMPANY Lic. No. F Class Contractor's Address_ Contractor's E-mail Address it State F_ Zip F_ Telephoned SETKS R SETBACKS FRONT PERMIT NO. L - SETBA� ' SETBACKS RIGHT PLAN CHECK NO. i USE ZONE DEVELOPMENT NO ( U G " PLAN CHECK FEES $