HomeMy WebLinkAboutX2021-2112 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Apsion plication
Comm'I r,, Residential NOTE: PILAN CH Kty of ort EES UE AT TIME OF uilding iSUBMITT - �/�" 7"fi,z l i z
fxBuilding JX_ Grading ,Drainage jX Elec FX_
r' Plum Cu Yd cuts Cu Yd Fill F
Project Address (Not mailing address) FX_
J>_� Fire rX Liq FX_ FX_N/A Floor Suite No
)gig _ S* '51-
F- �--
Description of Work
Use F—Const Type F_
# Stories # Units (if Res)s
®t�f 6' t 3 �5- LF 31
�C ��� S
Valuation $
Material/Labor t
New/AddSFF— _o RemodelSFF—o Garage/New/AddF
OWNER'S NAME Last f' u V1,
First 9/
Owner's E-mail Address
Owner's Addresps�
Q
City State % Zip F Telephone p P );wt R #qM
APPLICANT'S NAME Last (�� (�� y l
First _Pwr
Applicant's Address
Applicant's E-mail Address
I (W I t �` fi
j j
e,v, , eL_r4e, 601 LGI (/ 6,
pp�,�
City r Los Rr� ��_� State l i t Zip
fires) Telephone b ,)b6(j"'�/ 7y
v
ARCHITECT/DESIGNER'S NAME Last First r F_
Pi Lic. No.F_
Address
Architect/Designer's E-mail Address
City State F Zip F— Telephones
ENGINEER'S NAMEN Last
First Lic. No.F_
Engineer's Address
Engineer's E-mail Address
City I State Zip
[— Telephone[
CONTRACTOR'S NAME/COMPANY �� j?j)
Lic. No. � SI �', Class `(2
Contractor's Address
Contractor's E-mail Address
Ci �,* /� Lf State j f� Zi
Ty �✓S Ul d �� I �" zip
"!sd 7 d� Telephone i� �-�'E�� "�%ly.._..
/V -3 A,�
✓�
SETBACKS REAR SETBACKS FRONT
PERMIT NO. W 1
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. 9
USE ZONE DEVELOPMENT NO
''�� //�� q
PLAN CHECK FEES$ i2' 8-10