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Worksheet for Combo Building & Solar Permi# p ligation ,4? -w.
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMI L ✓ �,
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OWNER'S NAME LastL�k{\ h4V�
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Owner's Address
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Owner's E-mail Address
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APPLICANT'S NAME Last I tEN WI1MQ V—
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Applicant's Address
Applicant's E-mail Address
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ARCHITECT/DESINAME Last
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Architect/Designer's Address
Architect/Designees E-mail Address
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city _ State F Zip F------ Telephoned
ENGINEER'S NAME Last
First Lic. No.
Engineer's Address
Engineer's E-mail Address
City StateF ZIP
F TelephoneF_
CONTRACTOR'S NAME/COMPANY If A 1 I kC h CaIVS �L r� �( Lic. No. ` ,? (� 1 Z Class
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Contractor's Address
Contractor's E-mail Address
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SETBACKS REAR SETBACKS FRONT
PERMIT NO. A L V li bi J
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. Iry CA 710IR
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $