HomeMy WebLinkAboutX2016-4113 - Permit Application (2)Pri orm Worksheet for Combo Building & Solar Permit Application
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a. NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Description of Work
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OWNER'S NAME Last
Owner's Address
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APPLICANT'S NAME Last I Wr (2u-C
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Applicant's Address
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Owner's E-mail Address
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Suite No
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Valuation $
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Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last Q (iZ First (_Lt) A, L(_ Lic. No.
Architect/Designees Address
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Architect/Designer's E-mail Address
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ENGINEER'S NAME Last First K �,L
Engineer's Address
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Lic. No. ;.z Z41
Engineer's E-mailAddress
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CONTRACTOR'S NAME/COMPANY . Lic. No. Class
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Contractor's Address Contractor's E-mail Address
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SETBACKS REAR SETBACKS FRONT PERMIT NO. v[r s -ItI .
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. f1Yi 6 ` Gi V
USE_ ZONE DEVELOPMENT NO PLAN CHECK FEES $