HomeMy WebLinkAboutX2022-1083 - Permit Applicationacini Form ;,�
Worksheet for Combo Building & Solar Permit Application 3 aW'°"a
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NOTE: PLAN CHECty of K EES UE each - ATTIME OFuilding ISUBMITIY\='10I Jc<'oa
j— wilding F_ Grading [—Drainage (—Elec r—Mech F- Plum Cu Yd CutF Cu Yd Fill
Project Address (Not mailing ! Flood F_ Fire (` Liq r`" Landslide r -N/A Floor Suite No
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Description of Work AAOG) *W(f,74' 70�� / S'TXR` y0 N
Use /�
Vo Type V'g
# Stories # Units (if Res)
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Valuation $ r C2
Material/Labor
New/Add SF�—, Re F / j®��% Garage/New/Add----
OWNER'S NAME Last First
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Owner's Address-wrfers E-mail Address
city State Zip F—Telephone—
APPLICANT'S NAME Last �L//0 JI'X' _ First A X
Applicant's Address Applicant's E-mail Address -
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City L,aA �j(,,4A)> '.. State F( . Zip J'2(?L� TelephoneFW_
ARCHITECT/DESIGNER'S NAME Last /Vu 1EA-1 First XAs VO L Lic N
Architect/Designer's Address Architect/Designer's E-mail/Address
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City �— State ..—� p Telephoner--,
ENGINEER'S NAME Last FirstF Lic. No.F—
Engineer's Address Engineer's E-mail Address
City State F Zip-- Telephone
CONTRACTOR'S NAME/COMPANY Lic No. F_—Class
Contractor's Address Contractor's E-mail Address
City StateF Zip F—, Telephone—
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SETBACKS REAR SETBACKS FRONT PERMIT NO. X?.O'ZZ I Obi
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK N0. Odd 20 Z Z
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $